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Gobba S, Kibone W, Kiguba R. Self-reported gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs in female students with dysmenorrhoea at Makerere University: prevalence, discontinuation and associated factors. a cross sectional study. BMJ Open 2024; 14:e079660. [PMID: 38844394 PMCID: PMC11163621 DOI: 10.1136/bmjopen-2023-079660] [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: 09/19/2023] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Primary dysmenorrhoea occurs in up to 50% of menstruating females. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used therapeutic remedies for dysmenorrhoea in Uganda. However, NSAIDs are associated with a 3-5 fold increase in the risk of gastrointestinal (GI) adverse drug effects. OBJECTIVES We aimed to determine the prevalence and associated factors of self-reported NSAID-related GI adverse effects in female students who use NSAIDs in managing dysmenorrhoea-associated pain at Makerere University. DESIGN A cross-sectional study. SETTING Makerere University's main campus, situated North of Kampala, Uganda. PARTICIPANTS 314 female students pursuing an undergraduate programme at Makerere University and residing in different halls of residence and hostels. OUTCOMES Social demographic data, menstrual history and treatment data. RESULTS Overall, 314 valid responses were received from female students with a median age of 22 years (IQR: 18-29 years). The median age at menarche was 13 years (IQR: 9-18 years). 41% (n=129/314) of the respondents had used medication for dysmenorrhoea and 32% (n=41/129) of whom reported NSAID-associated GI adverse effects with nausea being the most frequently reported (44%, n=18/41)Factors independently associated with GI adverse effects were: age at menarche (p=0.026), duration of menstruation (p=0.030) and use of ibuprofen (p=0.005). Females taking ibuprofen for dysmenorrhoea were about four times as likely to have NSAID-associated GI adverse effects (adjusted OR 3.87, 95% CI 1.51 to 9.91) than those who did not receive ibuprofen. Logistic regression was used to determine factors associated with self-reported adverse effects of NSAIDs among the female students. A p<0.05 was considered statistically significant. CONCLUSION We found a considerably high prevalence of NSAID-related GI adverse effects driven by factors such as age at menarche and ibuprofen use.
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Affiliation(s)
| | | | - Ronald Kiguba
- Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Biały S, Iwaszko M, Świerkot J, Kolossa K, Wielińska J, Jeka S, Bogunia-Kubik K. Genetic variability of three common NK and γδ T cell receptor genes (FCγ3R, NCR3, and DNAM-1) and their role in Polish patients with rheumatoid arthritis and ankylosing spondylitis. Immunol Res 2024:10.1007/s12026-024-09488-3. [PMID: 38714580 DOI: 10.1007/s12026-024-09488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024]
Abstract
Various lymphocyte subpopulations, including NK cells as well as γδ T cells, have been considered an important element in the pathogenesis of autoimmune, inflammatory, rheumatic diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The aim of this study was to assess the potential role of polymorphic variations in the genes coding for three NK and γδ T cell receptors: NCR3, FCγR3A, and DNAM-1 (rs1052248, rs396991, and rs763361, respectively) in the disease susceptibility and the efficacy of treatment with TNF inhibitors. The study included 461 patients with RA, 168 patients with AS, and 235 voluntary blood donors as controls. The NCR3 rs1052248 AA homozygosity prevailed in RA in patients lacking rheumatoid factor (p = 0.044) as well as in those who manifested the disease at a younger age (p = 0.005) and had higher CRP levels after 12 weeks of anti-TNF therapy (p = 0.021). The FCγR3A rs396991 polymorphism was associated with pain visual analogue scale (VAS) values before the initiation of anti-TNF treatment. Lower VAS values were observed in the GG homozygous RA patients (p = 0.024) and in AS patients with the TT genotype (p = 0.012). Moreover, AS heterozygous patients with the TG genotype presented higher CRP levels in the 12th week of anti-TNF treatment (p = 0.021). The findings suggest that the NCR3 rs1052248 AA homozygosity may have an adverse effect on RA, while the T allele potentially plays a protective role in the development of AS. Moreover, the rs1052248 T allele and TT genotype appear to have a favorable impact on the response to anti-TNF therapy in RA patients.
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Affiliation(s)
- Sylwia Biały
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Milena Iwaszko
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Kolossa
- Clinical Department of Rheumatology and Connective Tissue Diseases, Jan Biziel Hospital University, No. 2, Bydgoszcz, Poland
| | - Joanna Wielińska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Sławomir Jeka
- Clinical Department of Rheumatology and Connective Tissue Diseases, Jan Biziel Hospital University, No. 2, Bydgoszcz, Poland
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.
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Alrayes MS, Altawili MA, Alsuabie SM, Sindi AW, Alharbi KM, Alsalhi KM, Al Alawi RM, Ali ID, Nasser AN, Alabdulrahim JM, Alkhaldi MH, Alhudhaif HM, Alotaibi SA. Surgical Interventions for the Management of Obesity-Related Joint Pain: A Narrative Review. Cureus 2024; 16:e59082. [PMID: 38800150 PMCID: PMC11128294 DOI: 10.7759/cureus.59082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Obesity-related joint pain is a common and debilitating condition that significantly impacts the quality of life, primarily due to the excess weight straining the joints. This results in inflammation and degeneration, which can cause pain, stiffness, and difficulty moving. We aimed to comprehensively review the literature discussing surgical interventions for obesity-related joint pain. We searched across databases (PubMed, Scopus, and Cochrane Library) to identify studies published between 2000 and 2023 that assessed surgical interventions for obesity-related joint pain. This review highlights the complex interplay of mechanical, inflammatory, and metabolic factors contributing to joint pain in obese individuals, highlighting both surgical and non-surgical interventions. Non-surgical interventions include weight loss, exercise, physical therapy, and medications. Surgical interventions include bariatric surgery and joint replacement surgery. Bariatric surgery significantly reduces body weight and improves the quality of life outcomes; however, multiple studies have found no improvement or worsening of joint pain post-surgery. Total joint arthroplasty has demonstrated good improvement in pain and function outcomes based on recent meta-analyses, although risks of complications are higher in obese patients. The treatment choice for obesity-related joint pain depends on the individual patient's circumstances. Non-surgical interventions are usually the first line of treatment. However, if these interventions are not effective, surgical interventions may be an option.
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Affiliation(s)
| | | | | | - Ahmad W Sindi
- General Practice, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Kawkab M Alharbi
- Surgery, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | | | | | | | - Alrashed N Nasser
- General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Hamad M Alhudhaif
- General Practice, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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4
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Le Rhun E, Oppong FB, van den Bent M, Wick W, Brandes AA, Taphoorn MJ, Platten M, Idbaih A, Clement PM, Preusser M, Golfinopoulos V, Gorlia T, Weller M. Thrombocytopenia limits the feasibility of salvage lomustine chemotherapy in recurrent glioblastoma: a secondary analysis of EORTC 26101. Eur J Cancer 2023; 178:13-22. [PMID: 36379185 DOI: 10.1016/j.ejca.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thrombocytopenia represents the main cause of stopping alkylating chemotherapy for toxicity. Here, we explored the incidence, and the consequences for treatment exposure and survival, of thrombocytopenia induced by lomustine in recurrent glioblastoma. METHODS We performed a retrospective analysis of the associations of thrombocytopenia with treatment delivery and outcome in EORTC 26101, a randomised trial designed to define the role of lomustine versus bevacizumab versus their combination in recurrent glioblastoma. RESULTS A total of 225 patients were treated with lomustine alone (median 1 cycle) (group 1) and 283 patients were treated with lomustine plus bevacizumab (median 3 lomustine cycles) (group 2). Among cycle delays and dose reductions of lomustine for toxicity, thrombocytopenia was the leading cause. Among 129 patients (57%) of group 1 and 187 patients (66%) of group 2 experiencing at least one episode of thrombocytopenia, 36 patients (16%) in group 1 and 93 (33%) in group 2 had their treatment modified because of thrombocytopenia. Lomustine was discontinued for thrombocytopenia in 16 patients (7.1%) in group 1 and in 38 patients (13.4%) in group 2. On adjusted analysis accounting for major prognostic factors, dose modification induced by thrombocytopenia was associated with inferior progression-free survival in patients with MGMT promoter-methylated tumours in groups 1 and 2. This effect was noted for overall survival, too, but only for group 2 patients. CONCLUSION Drug-induced thrombocytopenia is a major limitation to adequate exposure to lomustine chemotherapy in recurrent glioblastoma. Mitigating thrombocytopenia to enhance lomustine exposure might improve outcome in patients with MGMT promoter-methylated tumours.
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Affiliation(s)
- Emilie Le Rhun
- Departments of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Departments of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
| | | | | | - Wolfgang Wick
- Department of Neurology and Neurooncology Program at the National Center for Tumor Diseases, University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Alba A Brandes
- Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto Delle Scienze Neurologiche, Bologna, Italy
| | - Martin Jb Taphoorn
- Leiden University Medical Center, Departments of Neurology, Leiden, And Haaglanden Medical Center, The Hague, the Netherlands
| | - Michael Platten
- Medical Faculty Mannheim, MCTN, Department of Neurology, Mannheim, Germany
| | - Ahmed Idbaih
- Sorbonne Université, Institut Du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Paul M Clement
- Department of Oncology, KU Leuven, Leuven Cancer Institute-KU Leuven, Leuven, Belgium
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael Weller
- Departments of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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Chijioke-Okere M, Halim Abdullah A, Adlan Mohd Hir Z, Alinnor JI, Oguzie EE. Efficient photodegradation of paracetamol by integrated PES-ZnO photocatalyst sheets. INORG CHEM COMMUN 2022. [DOI: 10.1016/j.inoche.2022.110377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Paleari D, Cavalieri L. Morniflumate in the treatment of upper airways affections in adults: a review and meta-analysis. Minerva Med 2022; 113:853-863. [PMID: 35708048 DOI: 10.23736/s0026-4806.22.08200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We compared, by a meta-analytic process, the antipyretic and symptomatic activity, and the safety profile of morniflumate (ATC code: M01AX22) with those of other commonly used non-steroidal anti-inflammatory drugs (NSAIDs) in acute ear, nose and throat (ENT) diseases. EVIDENCE ACQUISITION Our search strategy was performed in various database, included Google Scholar, PubMed and Embase, the key word was "morniflumate". Interventional studies in adults with ENT or lower airway inflammatory diseases were compared in a meta-analysis for the number of symptom-free and fever-free patients at day 3 of therapy, and of drug interruptions due to adverse events (AEs). For symptoms, we included only studies on ENT inflammatory diseases; for fever and AEs, we also considered studies on lower airway inflammatory diseases. Of 33 studies retrieved, 8 (24.2%) met the inclusion criteria and compared morniflumate to placebo, nimesulide, paracetamol and other NSAIDs. EVIDENCE SYNTHESIS On day 3, the number of symptom-free patients was significantly higher with morniflumate vs placebo and nimesulide (+20% and +30%, respectively) and similar to the other comparators. The number of fever-free patients significantly increased (up to 70%) with morniflumate vs all comparators except paracetamol (similar). No difference was found in the number of AE-related interruptions. CONCLUSIONS morniflumate showed good antipyretic and symptomatic activity and a short-term safety profile at least comparable to that of other NSAIDs.
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Low-Dose NSAIDs Efficacy in Orthopedic Applications. Sports Med Arthrosc Rev 2022; 30:147-161. [PMID: 35921597 DOI: 10.1097/jsa.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) [cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitors] and COXIBs (the COX-2 selective inhibitors) may induce several potentially severe and life-threatening issues especially in elderly patients. The use of low-dose NSAIDs is associated with lower risk of side effects compared to the standard dosage. Low-dose NSAIDs could minimize the side effects of these drugs while maintaining their clinical efficacy and effectiveness. The present study evaluates the effectiveness and safety of low-dose NSAIDs in musculoskeletal applications.
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Ayares G, Idalsoaga F, Díaz LA, Arnold J, Arab JP. Current Medical Treatment for Alcohol-Associated Liver Disease. J Clin Exp Hepatol 2022; 12:1333-1348. [PMID: 36157148 PMCID: PMC9499849 DOI: 10.1016/j.jceh.2022.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/06/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol-associated liver disease is one of the main causes of chronic liver disease. It comprises a clinical-histologic spectrum of presentations, from steatosis, steatohepatitis, to different degrees of fibrosis, including cirrhosis and severe necroinflammatory disease, called alcohol-associated hepatitis. In this focused update, we aim to present specific therapeutic interventions and strategies for the management of alcohol-associated liver disease. Current evidence for management in all spectra of manifestations is derived from general chronic liver disease recommendations, but with a higher emphasis on abstinence and nutritional support. Abstinence should comprise the treatment of alcohol use disorder as well as withdrawal syndrome. Nutritional assessment should also consider the presence of sarcopenia and its clinical manifestation, frailty. The degree of compensation of the disease should be evaluated, and complications, actively sought. The most severe acute form of this disease is alcohol-associated hepatitis, which has high mortality and morbidity. Current treatment is based on corticosteroids that act by reducing immune activation and blocking cytotoxicity and inflammation pathways. Other aspects of treatment include preventing and treating hepatorenal syndrome as well as preventing infections although there is no clear evidence as to the benefit of probiotics and antibiotics in prophylaxis. Novel therapies for alcohol-associated hepatitis include metadoxine, interleukin-22 analogs, and interleukin-1-beta antagonists. Finally, granulocyte colony-stimulating factor, microbiota transplantation, and gut-liver axis modulation have shown promising results. We also discuss palliative care in advanced alcohol-associated liver disease.
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Key Words
- AC, Amoxicillin/clavulanate
- ACLF, Acute-on-Chronic Liver Failure
- ADLs, Activities of Daily Living
- AH, Alcohol-Associated Hepatitis
- AKI-HRS, Acute Kidney Injury - Hepatorenal Syndrome
- ALD
- ALD, Alcohol-Associated Liver Disease
- ASH, Alcoholic Steatohepatitis
- AUD, Alcohol Use Disorder
- AWS, Alcohol Withdrawal Syndrome
- BCAAs, Branched-Chain Amino Acids
- CDC, Center for Disease Control
- CI, Confidence Interval
- COVID-19, Coronavirus Disease 2019
- CT, Computerized Tomography
- GABA, gamma-aminobutyric acid agonist
- HBV, Hepatitis B Virus
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- HE, Hepatic Encephalopathy
- HIV, Human Immunodeficiency Virus
- HR, Hazard Ratio
- IBW, Ideal Body Weight
- ICA, International Club of Ascites
- IL-1β, Interleukin-1β
- IL-22, Interleukin-22
- KPS, Karnofsky Performance Status
- LB, Liver Biopsy
- LPS, Lipopolysaccharide
- LSM, Liver Stiffness Measurement
- LT, Liver Transplantation
- MDF, Maddrey’s Discriminant Function
- MELD, Model of End-Stage Liver Disease
- MRI, Magnetic Resonance Imaging
- MUST, Malnutrition Universal Screening Tool
- NIAAA, National Institute on Alcohol Abuse and Alcoholism
- NRS-2002, Nutritional Risk Screening-2002
- OR, Odds Ratio
- PAMPs, Pathogen-Activated Molecular Patterns
- PMI, Psoas Muscle Index
- PTX, Pentoxifylline
- RAI, Relative Adrenal Insufficiency
- RCT, Randomized Clinical Trials
- RFH-NPT, Royal Free Hospital-Nutritional Prioritizing Tool
- ROS, Reactive Oxygen Species
- RR, Relative Risk
- SIRS, Systemic Inflammatory Response Syndrome
- TNF, Tumor Necrosis Factor
- WKS, Wernicke-Korsakoff Syndrome
- alcohol
- alcohol use disorders
- alcohol-associated hepatitis
- cirrhosis
- fatty liver disease
- steatosis
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Affiliation(s)
- Gustavo Ayares
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Idalsoaga
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis A. Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Arnold
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P. Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Alchin J, Dhar A, Siddiqui K, Christo PJ. Why paracetamol (acetaminophen) is a suitable first choice for treating mild to moderate acute pain in adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, or who are older. Curr Med Res Opin 2022; 38:811-825. [PMID: 35253560 DOI: 10.1080/03007995.2022.2049551] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pain is among the most common reasons that people consult primary care physicians, who must weigh benefits versus risks of analgesics use for each patient. Paracetamol (acetaminophen) is a first-choice analgesic for many adults with mild to moderate acute pain, is generally well tolerated at recommended doses (≤4 g/day) in healthy adults and may be preferable to non-steroidal anti-inflammatory drugs that are associated with undesirable gastrointestinal, renal, and cardiovascular effects. Although paracetamol is widely used, many patients and physicians still have questions about its suitability and dosing, especially for older people or adults with underlying comorbidities, for whom there are limited clinical data or evidence-based guidelines. Inappropriate use may increase the risks of both overdosing and inadequate analgesia. To address knowledge deficits and augment existing guidance in salient areas of uncertainty, we have researched, reviewed, and collated published evidence and expert opinion relevant to the acute use of paracetamol by adults with liver, kidney, or cardiovascular diseases, gastrointestinal disorders, asthma, or/and who are older. A concern is hepatotoxicity, but this is rare among adults who use paracetamol as directed, including people with cirrhotic liver disease. Putative epidemiologic associations of paracetamol use with kidney or cardiovascular disease, hypertension, gastrointestinal disorders, and asthma largely reflect confounding biases and are of doubtful relevance to short-term use (<14 days). Paracetamol is a suitable first-line analgesic for mild to moderate acute pain in many adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, and/or who are older. No evidence supports routine dose reduction for older people. Rather, dosing for adults who are older and/or have decompensated cirrhosis, advanced kidney failure, or analgesic-induced asthma that is known to be cross-sensitive to paracetamol, should be individualized in consultation with their physician, who may recommend a lower effective dose appropriate to the circumstances.
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Affiliation(s)
- John Alchin
- Pain Management Centre, Burwood Hospital, Burwood, New Zealand
| | - Arti Dhar
- GlaxoSmithKline Consumer Healthcare Pte. Ltd, Singapore
| | | | - Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yennurajalingam S, Bruera E. Do Patients Benefit from a Trial of Corticosteroids at the End of Life? Curr Treat Options Oncol 2022; 23:796-805. [PMID: 35362799 DOI: 10.1007/s11864-022-00977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/03/2022]
Abstract
OPINION STATEMENT Patients with advanced cancer in the last 6 months of their lives have a higher frequency of distressing and debilitating physical and psychosocial symptoms such as cancer pain, cancer-related fatigue (CRF), anorexia, shortness of breath, poor sleep, anxiety, and depression. Often these symptoms significantly impact the patients' quality of life, and therefore require prompt assessment and effective treatment. There are specific treatments for certain distressing cancer-related symptoms (e.g., opioids for pain), but for the other symptoms such as CRF, anorexia-cachexia, and shortness of breath, there are limited or no evidence-based treatments. Also, in the management of cancer pain in this population, many patients are refractory to opioids. Hence, corticosteroids are one of the most common adjuvant medications prescribed for the management of this distressing symptom. However, there is limited evidence in regard to the effectiveness of corticosteroids in the improvement of the symptoms, side-effect profile, most optimal duration of use, dose, type of steroid, and most recently, the use with immunotherapy in advanced cancer patients at the end of life. These factors significantly limit the use of this important medication in terminally ill cancer patients. Further research is therefore critical to provide the optimal prescription of corticosteroids in this highly distressed population.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #1414, Houston, TX, 77030, USA.
| | - Eduardo Bruera
- Department of Palliative Care Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #1414, Houston, TX, 77030, USA
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Medrano-Jiménez E, Meza-Sosa KF, Urbán-Aragón JA, Secundino I, Pedraza-Alva G, Pérez-Martínez L. Microglial activation in Alzheimer's disease: The role of flavonoids and microRNAs. J Leukoc Biol 2022; 112:47-77. [PMID: 35293018 DOI: 10.1002/jlb.3mr1021-531r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of senile dementia and is characterized by progressive cognitive impairment and neuronal degeneration. Microglial activation is an important pathologic hallmark of AD. During disease progression, microglial cells switch from an alternative or anti-inflammatory and neuroprotective profile (M2) to a classic or proinflammatory and neurotoxic profile (M1). Phenotypically, M1 microglia is characterized by the activation of inflammatory signaling pathways that cause increased expression of proinflammatory genes, including those coding for cytokines and chemokines. This microglia-mediated neuroinflammation contributes to neuronal cell death. Recent studies in microglial cells have shown that a group of plant-derived compounds, known as flavonoids, possess anti-inflammatory properties and therefore exert a neuroprotective effect through regulating microglia activation. Here, we discuss how flavonoids can promote the switch from an inflammatory M1 phenotype to an anti-inflammatory M2 phenotype in microglia and how this represents a valuable opportunity for the development of novel therapeutic strategies to blunt neuroinflammation and boost neuronal recovery in AD. We also review how certain flavonoids can inhibit neuroinflammation through their action on the expression of microglia-specific microRNAs (miRNAs), which also constitute a key therapeutic approach in different neuropathologies involving an inflammatory component, including AD. Finally, we propose novel targets of microglia-specific miRNAs that may be considered for AD treatment.
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Affiliation(s)
- Elisa Medrano-Jiménez
- Laboratorio de Neuroinmunobiología, Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Morelos, México
| | - Karla F Meza-Sosa
- Laboratorio de Neuroinmunobiología, Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Morelos, México
| | - José A Urbán-Aragón
- Laboratorio de Neuroinmunobiología, Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Morelos, México
| | - Ismael Secundino
- Universidad De La Salle Bajío, Facultad de Odontología y Escuela de Veterinaria, León-Guanajuato, México
| | - Gustavo Pedraza-Alva
- Laboratorio de Neuroinmunobiología, Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Morelos, México
| | - Leonor Pérez-Martínez
- Laboratorio de Neuroinmunobiología, Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Morelos, México
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Uivaraseanu B, Vesa C, Tit D, Abid A, Maghiar O, Maghiar T, Hozan C, Nechifor A, Behl T, Patrascu J, Bungau S. Therapeutic approaches in the management of knee osteoarthritis (Review). Exp Ther Med 2022; 23:328. [DOI: 10.3892/etm.2022.11257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Bogdan Uivaraseanu
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Cosmin Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Delia Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Areha Abid
- Department of Food Science, Faculty of Agricultural and Food Sciences, University of Debrecen, Debrecen 4032, Hungary
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Teodor Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Calin Hozan
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Aurelia Nechifor
- Department of Analytical Chemistry and Environmental Engineering, Polytechnic University of Bucharest, Bucharest 011061, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Jenel Patrascu
- Department of Orthopedics, Urology and Medical Imaging, Faculty of Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
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13
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Hybrid Hyaluronic Acid versus High Molecular Weight Hyaluronic Acid for the Treatment of Hip Osteoarthritis in Overweight/Obese Patients. J Funct Morphol Kinesiol 2022; 7:jfmk7010020. [PMID: 35225906 PMCID: PMC8883906 DOI: 10.3390/jfmk7010020] [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: 01/04/2022] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500−2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patients.
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Abdelghffar EA, Barakat A, Torky ZA, Mohamed IK, Ali K. Pink Cedar (Acrocarpus fraxinifolius): its prophylactic role vs APAP–induced toxicity in rats and its antiviral activity vs HSV-1. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2021.2021007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Eman A. Abdelghffar
- Biology Department, College of Science, Taibah University, Medina, Saudi Arabia
- Zoology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Alaa Barakat
- Department of Biochemistry and Biotechnology, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Zenab A. Torky
- Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Ihab K. Mohamed
- Zoology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Kamela Ali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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15
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du Preez HN, Aldous C, Hayden MR, Kruger HG, Lin J. Pathogenesis of COVID-19 described through the lens of an undersulfated and degraded epithelial and endothelial glycocalyx. FASEB J 2021; 36:e22052. [PMID: 34862979 DOI: 10.1096/fj.202101100rr] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
The glycocalyx surrounds every eukaryotic cell and is a complex mesh of proteins and carbohydrates. It consists of proteoglycans with glycosaminoglycan side chains, which are highly sulfated under normal physiological conditions. The degree of sulfation and the position of the sulfate groups mainly determine biological function. The intact highly sulfated glycocalyx of the epithelium may repel severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) through electrostatic forces. However, if the glycocalyx is undersulfated and 3-O-sulfotransferase 3B (3OST-3B) is overexpressed, as is the case during chronic inflammatory conditions, SARS-CoV-2 entry may be facilitated by the glycocalyx. The degree of sulfation and position of the sulfate groups will also affect functions such as immune modulation, the inflammatory response, vascular permeability and tone, coagulation, mediation of sheer stress, and protection against oxidative stress. The rate-limiting factor to sulfation is the availability of inorganic sulfate. Various genetic and epigenetic factors will affect sulfur metabolism and inorganic sulfate availability, such as various dietary factors, and exposure to drugs, environmental toxins, and biotoxins, which will deplete inorganic sulfate. The role that undersulfation plays in the various comorbid conditions that predispose to coronavirus disease 2019 (COVID-19), is also considered. The undersulfated glycocalyx may not only increase susceptibility to SARS-CoV-2 infection, but would also result in a hyperinflammatory response, vascular permeability, and shedding of the glycocalyx components, giving rise to a procoagulant and antifibrinolytic state and eventual multiple organ failure. These symptoms relate to a diagnosis of systemic septic shock seen in almost all COVID-19 deaths. The focus of prevention and treatment protocols proposed is the preservation of epithelial and endothelial glycocalyx integrity.
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Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Melvin R Hayden
- Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Diabetes and Cardiovascular Disease Center, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
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16
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McEvoy L, Carr DF, Pirmohamed M. Pharmacogenomics of NSAID-Induced Upper Gastrointestinal Toxicity. Front Pharmacol 2021; 12:684162. [PMID: 34234675 PMCID: PMC8256335 DOI: 10.3389/fphar.2021.684162] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs which are widely used globally for the treatment of pain and inflammation, and in the case of aspirin, for secondary prevention of cardiovascular disease. Chronic non-steroidal anti-inflammatory drug use is associated with potentially serious upper gastrointestinal adverse drug reactions (ADRs) including peptic ulcer disease and gastrointestinal bleeding. A few clinical and genetic predisposing factors have been identified; however, genetic data are contradictory. Further research is needed to identify clinically relevant genetic and non-genetic markers predisposing to NSAID-induced peptic ulceration.
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Affiliation(s)
- L McEvoy
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - D F Carr
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - M Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
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17
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Yeap SS, Abu Amin SR, Baharuddin H, Koh KC, Lee JK, Lee VKM, Mohamad Yahaya NH, Tai CC, Tan MP. A Malaysian Delphi consensus on managing knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:514. [PMID: 34088302 PMCID: PMC8178929 DOI: 10.1186/s12891-021-04381-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA. METHODS A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus' core messages. RESULTS A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers. CONCLUSIONS This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, No. 1, Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia.
| | | | - Hazlyna Baharuddin
- Department of Internal Medicine, Universiti Teknologi MARA, Kampus Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Kar Chai Koh
- Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, 52100, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Joon Kiong Lee
- Department of Orthopaedic Surgery, Beacon Hospital, Jalan Templer, Section 51, 46050, Petaling Jaya, Selangor, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Hamdan Mohamad Yahaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Cheh Chin Tai
- Department of Orthopaedic Surgery, Ara Damansara Medical Centre, Jalan Lapangan Terbang Subang, Seksyen U2, 40150, Shah Alam, Selangor, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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Comparable efficacy of 100 mg aspirin twice daily and rivaroxaban for venous thromboembolism prophylaxis following primary total hip arthroplasty: a randomized controlled trial. Chin Med J (Engl) 2021; 134:164-172. [PMID: 33410616 PMCID: PMC7817327 DOI: 10.1097/cm9.0000000000001305] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA. Methods: Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications. Results: We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5–1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4–1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8–83.0], Rivaroxaban: 81.0 [79.3–83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0–92.0], Rivaroxaban: 91.5 [88.3–92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29). Conclusion: In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs. Trial Registration: Chictr.org, ChiCTR18000202894; http://www.chictr.org.cn/showproj.aspx?proj=33284
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19
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Przybyła GW, Szychowski KA, Gmiński J. Paracetamol - An old drug with new mechanisms of action. Clin Exp Pharmacol Physiol 2021; 48:3-19. [PMID: 32767405 DOI: 10.1111/1440-1681.13392] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
Paracetamol (acetaminophen) is the most commonly used over-the-counter (OTC) drug in the world. Despite its popularity and use for many years, the safety of its application and its mechanism of action are still unclear. Currently, it is believed that paracetamol is a multidirectional drug and at least several metabolic pathways are involved in its analgesic and antipyretic action. The mechanism of paracetamol action consists in inhibition of cyclooxygenases (COX-1, COX-2, and COX-3) and involvement in the endocannabinoid system and serotonergic pathways. Additionally, paracetamol influences transient receptor potential (TRP) channels and voltage-gated Kv7 potassium channels and inhibits T-type Cav3.2 calcium channels. It also exerts an impact on L-arginine in the nitric oxide (NO) synthesis pathway. However, not all of these effects have been clearly confirmed. Therefore, the aim of our paper was to summarize the current state of knowledge of the mechanism of paracetamol action with special attention to its safety concerns.
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Affiliation(s)
| | - Konrad A Szychowski
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Jan Gmiński
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
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20
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Feng Z, Cao J, Zhang Q, Lin L. The drug likeness analysis of anti-inflammatory clerodane diterpenoids. Chin Med 2020; 15:126. [PMID: 33298100 PMCID: PMC7727157 DOI: 10.1186/s13020-020-00407-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammation is an active defense response of the body against external stimuli. Long term low-grade inflammation has been considered as a deteriorated factor for aging, cancer, neurodegeneration and metabolic disorders. The clinically used glucocorticoids and non-steroidal anti-inflammatory drugs are not suitable for chronic inflammation. Therefore, it's urgent to discover and develop new effective and safe drugs to attenuate inflammation. Clerodane diterpenoids, a class of bicyclic diterpenoids, are widely distributed in plants of the Labiatae, Euphorbiaceae and Verbenaceae families, as well as fungi, bacteria, and marine sponges. Dozens of anti-inflammatory clerodane diterpenoids have been identified on different assays, both in vitro and in vivo. In the current review, the up-to-date research progresses of anti-inflammatory clerodane diterpenoids were summarized, and their druglikeness was analyzed, which provided the possibility for further development of anti-inflammatory drugs.
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Affiliation(s)
- Zheling Feng
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, People's Republic of China
| | - Jun Cao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, People's Republic of China
| | - Qingwen Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, People's Republic of China
| | - Ligen Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, People's Republic of China.
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21
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Berardicurti O, Ruscitti P, Pavlych V, Conforti A, Giacomelli R, Cipriani P. Glucocorticoids in rheumatoid arthritis: the silent companion in the therapeutic strategy. Expert Rev Clin Pharmacol 2020; 13:593-604. [PMID: 32434398 DOI: 10.1080/17512433.2020.1772055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Glucocorticoids (GCs) are key actors in RA management, despite the increasing number of available drugs. In fact, due to their efficacy and safety, the combination therapy between GCs and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is still recommended in the early phase of RA treatment, because improving the long-term results. AREAS COVERED In this paper, we reviewed the role of GCs in RA management, focusing on mechanisms of action as well as the benefit/risk ratio of GCs and newer therapeutic formulations. Furthermore, we analyzed GCs DMARDs proprieties on disease activity and their long-term effects on radiographic damage. We designed a narrative review aimed to provide an overview concerning GCs in RA management. EXPERT OPINION A large amount of evidence supports the use of GCs in RA, especially in the earliest phases of the disease. Besides GCs symptomatic effects due to their strong anti-inflammatory effects, data from several randomized clinical trials have shown a substantial benefit of low-dose GCs in inhibiting the radiographic damage, thus highlighting GCs DMARDs properties. Besides their recognized role in the treatment of early RA, systematic monitoring of adverse events should be recommended to minimize GCs toxicity.
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Affiliation(s)
- Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
| | - Viktoriya Pavlych
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
| | - Alessandro Conforti
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
| | - Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila , L'Aquila, Italy
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Sakata S, Kunimatsu R, Tsuka Y, Nakatani A, Hiraki T, Gunji H, Hirose N, Yanoshita M, Putranti NAR, Tanimoto K. High-Frequency Near-Infrared Diode Laser Irradiation Attenuates IL-1β-Induced Expression of Inflammatory Cytokines and Matrix Metalloproteinases in Human Primary Chondrocytes. J Clin Med 2020; 9:jcm9030881. [PMID: 32213810 PMCID: PMC7141534 DOI: 10.3390/jcm9030881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 01/15/2023] Open
Abstract
High-frequency near-infrared diode laser provides a high-peak output, low-heat accumulation, and efficient biostimulation. Although these characteristics are considered suitable for osteoarthritis (OA) treatment, the effect of high-frequency near-infrared diode laser irradiation in in vitro or in vivo OA models has not yet been reported. Therefore, we aimed to assess the biological effects of high-frequency near-infrared diode laser irradiation on IL-1β-induced chondrocyte inflammation in an in vitro OA model. Normal Human Articular Chondrocyte-Knee (NHAC-Kn) cells were stimulated with human recombinant IL-1β and irradiated with a high-frequency near-infrared diode laser (910 nm, 4 or 8 J/cm2). The mRNA and protein expression of relevant inflammation- and cartilage destruction-related proteins was analyzed. Interleukin (IL) -1β treatment significantly increased the mRNA levels of IL-1β, IL-6, tumor necrosis factor (TNF) -α, matrix metalloproteinases (MMP) -1, MMP-3, and MMP-13. High-frequency near-infrared diode laser irradiation significantly reduced the IL-1β-induced expression of IL-1β, IL-6, TNF-α, MMP-1, and MMP-3. Similarly, high-frequency near-infrared diode laser irradiation decreased the IL-1β-induced increase in protein expression and secreted levels of MMP-1 and MMP-3. These results highlight the therapeutic potential of high-frequency near-infrared diode laser irradiation in OA.
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Affiliation(s)
| | - Ryo Kunimatsu
- Correspondence: ; Tel.: +81-82-257-5686; Fax: +81-82-257-5687
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Varrassi G, Pergolizzi JV, Dowling P, Paladini A. Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review. Adv Ther 2020; 37:61-82. [PMID: 31705437 DOI: 10.1007/s12325-019-01144-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 02/06/2023]
Abstract
Ibuprofen first came to market about 50 years ago and rapidly moved to over-the-counter (OTC) sales. In April 2019, the National Agency for the Safety of Medicines and Health Products (ANSM) of France issued a warning for NSAID uses by patients with infectious diseases based on an analysis of 20 years of real-world safety data on ibuprofen and ketoprofen. Nevertheless, ibuprofen remains a mainstay in the analgesic armamentarium and with numerous randomized clinical trials, head-to-head studies, and decades of clinical experience. The authors offer a review of the safety of ibuprofen and how it may differ from other NSAIDs. Ibuprofen is associated with certain well-known gastrointestinal adverse effects that are related to dose and patient population. Among nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen has a comparatively low risk of cardiovascular adverse effects. It has been associated with renal and hepatic adverse effects, which appear to depend on dose, concomitant medications, and patient population. The association of ibuprofen with infections is more complex in that it confers risk in some situations but benefits in others, the latter in cystic fibrosis. Emerging interest in the literature is providing evidence of the role of ibuprofen as a possible endocrine disrupter as well as its potential antiproliferative effects for cancer cells. Taken altogether, ibuprofen has a favorable safety profile and is an effective analgesic for many acute and chronic pain conditions, although it-like other NSAIDs-is not without risk. After 50 years, evidence is still emerging about ibuprofen and its unique safety profile among NSAIDs. FUNDING: The Rapid Service Fee was funded by Abbott Established Pharmaceuticals Division (EPD).
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Via Tacito 7, 00193, Rome, Italy.
- World Institute of Pain, Winston-Salem, USA.
| | | | - Pascal Dowling
- Abbott Product Operations AG, Allschwil, EPD Headquarters, Hegenheimermattweg 127, 4123, Allschwil, Switzerland
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Li L, Wang D, Wang X, Bai R, Wang C, Gao Y, Anastassiades T. N-Butyrylated hyaluronic acid ameliorates gout and hyperuricemia in animal models. PHARMACEUTICAL BIOLOGY 2019; 57:717-728. [PMID: 31622116 PMCID: PMC8871623 DOI: 10.1080/13880209.2019.1672755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Context: Hyaluronic acid (HA) plays critical roles in the structural skeleton, joint lubrication, renal function and cell signaling. We previously showed that partially N-butyrylated, low molecular weight, hyaluronic acid (BHA) exhibited an anti-inflammatory effect in cultured human macrophage, where inflammation was induced either by a TL-4 agonist or the low molecular weight HA itself, in dose-dependent fashion. Objectives: To investigate the anti-inflammatory, antioxidative, and antihyperuricemic effects of BHA using animal models of acute gouty arthritis and hyperuricemia. Materials and methods: The anti-inflammatory effect of articular BHA (10 and 50 μg) injections was evaluated by measuring joint swelling and the serum levels of inflammatory cytokines in a model of acute gouty arthritis induced by intra-articular injection of monosodium urate crystals in Wistar rats (n = 10/group), in comparison to the control group with saline injection. Antioxidative and antihyperuricemic activities were investigated using intraperitoneal injections of oteracil potassium and yeast extract hyperuricemic Balb/C mice, which were treated with intraperitoneal injection of BHA at day 6-8 in the model. Results: In the gouty arthritis rat model, BHA at a higher dosage (50 μg) demonstrated a strong anti-inflammatory effect by reducing the degree of articular swelling and the serum levels of IL-1β, IL-8, IFN-γ, and MCP-1 by 5.56%, 6.55%, 15.58% and 33.18%. In the hyperuricemic mouse model, lower dosage BHA (10 μg) was sufficient to provide antioxidative activities by significantly decreasing the ROS levels in both serum and liver by 14.87% and 8.04%, while improving liver SOD by 12.77%. Intraperitoneal injection of BHA suppressed uric acid production through reducing liver XO activity by 19.78% and decreased the serum uric acid level in hyperuricemic mice by 30.41%. Conclusions: This study demonstrated for the first time that BHA exhibits anti-inflammatory, antioxidative and antihyperuricemic effects in vivo, suggesting a potential therapeutic application of BHA in gouty arthritis and hyperuricemia.
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Affiliation(s)
- Lanzhou Li
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Di Wang
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Xueju Wang
- Pathology Department of China–Japan Union Hospital, Jilin University, Changchun, China
| | - Ruifeng Bai
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Chunyu Wang
- State Key Laboratory of Supramolecular Structure and Materials, Jilin University, Changchun, China
| | - Yin Gao
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
- CONTACT Yin Gao School of Life Sciences, Jilin University, Changchun130012, China
| | - Tassos Anastassiades
- Division of Rheumatology, Department of Medicine, Queen’s University, Kingston, Canada
- Tassos Anastassiades Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario K7L 3N6, Canada
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Le Rhun E, Devos P, Houillier C, Cartalat S, Chinot O, Di Stefano AL, Lepage C, Reyns N, Dubois F, Weller M. Romiplostim for temozolomide-induced thrombocytopenia in glioblastoma: The PLATUM trial. Neurology 2019; 93:e1799-e1806. [PMID: 31586022 DOI: 10.1212/wnl.0000000000008440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/29/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the efficacy of the thrombopoietin receptor agonist romiplostim for the prevention of temozolomide-induced thrombocytopenia in newly diagnosed glioblastoma. METHODS In the PLATUM phase II open-label, multicenter, single-arm trial, patients diagnosed with Common Terminology Criteria for Adverse Events grade 3 or 4 thrombocytopenia during chemoradiotherapy received weekly subcutaneous romiplostim injections. PLATUM aimed at demonstrating that the percentage of thrombocytopenic patients treated with romiplostim able to complete 6 cycles of maintenance temozolomide chemotherapy exceeded 10% (p0 = 0.10; pA = 0.35). Using type I error equal to 0.05% and 95% power, 31 patients had to be recruited. According to a Fleming 2-step design with a preplanned interim analysis after recruitment of 20 patients (step 1), the trial was terminated early for success. RESULTS Twenty patients were enrolled in step 1. Median age was 61 years (range 33-73). Twelve patients received 6 temozolomide cycles, corresponding to a success rate of 60% (95% confidence interval 36%-81%). Four patients discontinued temozolomide because they did not respond to romiplostim, 2 for progression, and 2 for adverse events unrelated to romiplostim. CONCLUSION The thrombopoietin receptor agonist romiplostim improves exposure to chemotherapy in patients with glioblastoma experiencing temozolomide-induced thrombocytopenia. CLINICALTRIALSGOV IDENTIFIER NCT02227576. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with glioblastoma and thrombocytopenia, romiplostim is effective for the secondary prophylaxis of temozolomide-induced thrombocytopenia.
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Affiliation(s)
- Emilie Le Rhun
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Patrick Devos
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Caroline Houillier
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Stéphanie Cartalat
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Olivier Chinot
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Anna Luisa Di Stefano
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Clément Lepage
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Nicolas Reyns
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - François Dubois
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
| | - Michael Weller
- From the General and Stereotaxic Neurosurgery Service, Neuro-oncology (E.L.R.), EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (P.D.) and Onco thAI, INSERM U1189 (N.R.), Université de Lille, Research Federation (C.L.), and Department of Neurosurgery (N.R., F.D.), CHU Lille; Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM (C.H.), and Service de Neurologie 2-Mazarin (A.L.D.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neuro-oncologie (S.C.), Hospices Civils de Lyon, Hôpital Neurologique; Service de Neuro-Oncologie (O.C.), Aix-Marseille University, AP-HM, CHU Timone, Marseille, France; and Department of Neurology & Brain Tumor Center (M.W.), University Hospital and University of Zurich, Switzerland
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De Lucia O, Pierannunzii LM, Pregnolato F, Verduci E, Crotti C, Valcamonica E, Pisoni L, Comi D, Lonati PA, Meroni PL, Murgo A. Effectiveness and Tolerability of Repeated Courses of Viscosupplementation in Symptomatic Hip Osteoarthritis: A Retrospective Observational Cohort Study of High Molecular Weight vs. Medium Molecular Weight Hyaluronic Acid vs. No Viscosupplementation. Front Pharmacol 2019; 10:1007. [PMID: 31616292 PMCID: PMC6768944 DOI: 10.3389/fphar.2019.01007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Nonsurgical management of symptomatic hip osteoarthritis needs real-world evidence. We evaluated the effectiveness and tolerability of US-guided intra-articular treatment of two hyaluronic acids (HAs) commercially available in Italy and investigated predictors of response. Methods: Outpatient records including three cohorts: 122 subjects treated with medium (1,500–3,200 kDa; Hyalubrix®) molecular weight (MW) or high (hylan G-F20; Synvisc®) MW HAs and 20 controls taking NSAIDs/analgesics on demand were retrospectively analyzed. Pain VAS score, WOMAC, NSAID/analgesic consumption, and causes of suspension were available at 1, 6, 12, and 24 months after first administration. As selection bias usually affects observational retrospective studies, a quasi-randomization process was attained by performing propensity score approach. Results: Propensity score adjustment successfully allowed comparisons among balanced groups of treatments. VAS and WOMAC considerably decreased over time in treated groups independently of the radiological grade (p<0.001). On the other hand, the control group showed only a slight and rather uneven variation in VAS. Mean score changes were comparable in both HA cohorts from the earliest stages (ΔVAS(HA1,500–3,200kDa)T1vsT0 = −20%; ΔVAS(hylan G-F20)T1vsT0 = −23%/ΔWOMAC(HA1,500–3,200kDa)T1vsT0 = −17%; ΔWOMAC(hylan G-F20)T1vsT0 = −19%), reaching a further substantial reduction after 12 months (ΔVAS(HA1,500–3,200kDa)T12vsT0 = −52%; ΔVAS(hylan G-F20)T12vsT0 = −53%/ΔWOMAC(HA1,500–3,200kDa)T12vsT0 = −45%; and ΔWOMAC(hylan G-F20)T12vsT0 = −47%). Almost 11% (=13/122) of ineffectiveness and few moderate local side effects 3% (=4/122) were detected. Conclusions: Viscosupplementation in a real-life setting seems to provide a sound alternative in pain management in comparison to oral NSAIDs/analgesics, guaranteeing a reduced intake of pain killer medications. Analgesic effectiveness, functional recovery, and reduced joint stiffness extend and improve over 12 and 24 months, suggesting that repeated administrations achieve an additive effect.
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Affiliation(s)
- Orazio De Lucia
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
| | - Luca Massimo Pierannunzii
- Department of Orthopedics, Sports Traumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
| | - Francesca Pregnolato
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Elisa Verduci
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Messina, Messina, Italy
| | - Chiara Crotti
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,DISCCO-Department of Clinical Science and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Elisabetta Valcamonica
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Division of Internal Medicine and Cardiological Rehabilitation, Angelo Bellini Hospital - ASST Valle Olona, Somma Lombardo, Italy
| | - Laura Pisoni
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Rheumatology Outpatient Clinic, ASST Nord Milano, Milano, Italy
| | - Daniela Comi
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Department of Rehabilitation, ASST Lecco, Lecco, Italy
| | - Paola Adele Lonati
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Antonella Murgo
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
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Abstract
Osteoarthritis (OA) is a major cause of pain and physical disability in adults, and an increasingly common disease given its associations with aging and a growing obese/overweight population. Paracetamol is widely recommended for analgesia at an early stage in the management of OA, and, although frequently prescribed, evidence suggests the efficacy of paracetamol for OA pain is low. Furthermore, there have been recent concerns over the safety profile of paracetamol, with reports of gastrointestinal, cardiovascular, hepatic and renal adverse events. This narrative review summarizes recent literature on the benefits and harms of paracetamol for OA pain. Data on long-term paracetamol safety are derived largely from observational evidence, and are difficult to interpret given the potential biases of such data. Nonetheless, a considerable degree of toxicity is associated with paracetamol use among the general population, especially at the upper end of standard analgesic doses. Paracetamol is linked to liver function abnormalities and there is evidence for liver failure associated with non-intentional paracetamol overdose. Safety data for paracetamol use in the older population (aged >65 years) are sparse; however, there is some evidence that frail elderly people may have impaired paracetamol clearance. Given that the analgesic benefit of paracetamol in OA joint pain is uncertain and potential safety issues have been raised, more careful consideration of its use is required.
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Rainsford KD, Roberts MS, Nencioni A, Jones C. Rationale and evidence for the incorporation of heparin into the diclofenac epolamine medicated plaster. Curr Med Res Opin 2019; 35:989-1002. [PMID: 30474433 DOI: 10.1080/03007995.2018.1551194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The nonsteroidal anti-inflammatory drug (NSAID) diclofenac epolamine (DHEP) formulated as a topical patch has demonstrated efficacy and safety in the localized treatment of acute pain from minor strains, sprains and contusions, and for epicondylitis and knee osteoarthritis. The glycosaminoglycan heparin enhances the activity of topical NSAIDs formulated as a medicated plaster, even in the absence of any significant release of heparin. Therefore, DHEP plus, a new formulation of the DHEP medicated plaster containing a small amount of heparin sodium as excipient, has been developed. METHODS We reviewed the pivotal and supportive studies of the clinical development program of the new patch and evaluated the role of heparin as an enhancer in the treatment of localized pain/inflammation of musculoskeletal structures, associated with post-traumatic and/or rheumatic conditions. RESULTS The data was consistent with the concept that heparin increased the clinical activity of the DHEP plus medicated plaster versus the reference DHEP medicated plaster through improved bioavailability due to enhanced movement of diclofenac from the plaster. Both DHEP formulations have the same dissolution profile, indicating that heparin does not change the physical and chemical characteristics of the plaster. Permeation testing showed that heparin is not released from the DHEP plus medicated plaster. Efficacy studies showed that the DHEP plus medicated plaster was significantly more effective in reducing pain than the reference marketed DHEP medicated plaster. CONCLUSIONS The benefit/risk assessment of DHEP plus 180 mg medicated plaster is favorable, with a safety profile equal to placebo and improved efficacy over the reference marketed DHEP medicated plaster.
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Affiliation(s)
- K D Rainsford
- a Biomedical Sciences, Biomedical Research Centre, Sheffield Hallam University , Sheffield , United Kingdom
| | - Michael S Roberts
- b School of Pharmacy and Medical Sciences , University of South Australia , Adelaide , South Australia , Australia
- c Therapeutics Research Centre, the University of Queensland Diamantina Institute, Translational Research Institute , Brisbane , Australia
| | - Alessandro Nencioni
- d Analytical Development and Validation Laboratory , IBSA Institut Biochimique , Pambio-Noranco , Lugano , Switzerland
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Mirkov S. Reducing clinical risks associated with the pharmacological treatment of acute gout attacks. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chi TY, Zhu HM, Zhang M. Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing. Medicine (Baltimore) 2018; 97:e0665. [PMID: 29718891 PMCID: PMC6392961 DOI: 10.1097/md.0000000000010665] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal (GI) bleeding is an unwanted side effect common to all chemical types of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in elderly people. However, the risk factors of GI bleeding associated with NSAIDs for elderly people remain unknown. This study aims to evaluate the risks of GI bleeding associated with NSAIDs in 4728 elderly people over 60 years old based on database from a hospital in Beijing.This retrospective hospital-based study included 4728 patients over 60 years old prescribed with NSAIDs, of which 928 patients had GI bleeding and 3800 did not have. Odds ratios (OR) for the risk of GI bleeding associated with NSAIDs were determined by logistic regression analysis. Mean Decrease Gini (MDG) involved in random forest algorithm was used to rank the associated factors with GI bleeding.In multivariate analysis, family history of GI bleeding (OR, 3.348; P = .000), history of peptic ulcers (OR, 4.068; P = .000), history of cardiovascular and cerebrovascular disease (OR, 1.476; P = .001), diabetes mellitus (OR, 1.408; P = .000), antiplatelet drugs (OR, 3.106; P = .000), Helicobacter pylori infection (OR, 1.312; P = .001), cholesterol level (OR, 0.516; P = .000), upper abdominal discomfort (OR, 3.467; P = .000), anorexia (OR, 2.038; P = .000), and NSAIDs used for 0.5 to 3 months (OR, 0.780; P = .000) were associated with GI bleeding. After ranked the MDG of each factor, the top 5 ranked factors associated with GI bleeding were melena, hematemesis, antiplatelet drugs, cholesterol level, and upper abdominal discomfort.We found that family history of GI bleeding, history of peptic ulcers, history of cardiovascular and cerebrovascular disease, diabetes mellitus, antiplatelet drugs, Helicobacter pylori infection, hypocholesterolemia, and NSAIDs used for 0.5 to 3 months were independent risk factors for GI bleeding on people over 60 years old. Meanwhile, upper abdominal discomfort might be the predictor of GI bleeding associated with NSAIDs elderly users.
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Affiliation(s)
- Tian-Yu Chi
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Khan M, Adili A, Winemaker M, Bhandari M. Management of osteoarthritis of the knee in younger patients. CMAJ 2018; 190:E72-E79. [PMID: 29358201 PMCID: PMC5780266 DOI: 10.1503/cmaj.170696] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont.
| | - Anthony Adili
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | | | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
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Status of etoricoxib in the treatment of rheumatic diseases. Expert panel opinion. Reumatologia 2017; 55:290-297. [PMID: 29491537 PMCID: PMC5825967 DOI: 10.5114/reum.2017.72626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023] Open
Abstract
Pain is one of the most disabling symptoms of rheumatoid diseases. Patients with pain secondary to osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) or gout require effective analgesic treatment, and the physician’s task is to select a drug that is best suited for an individual patient. The choice of pharmacotherapy should be based both on drug potency and clinical efficacy, and its safety profile, particularly in the elderly population, as the number of comorbidities (and hence the risk of treatment complications and drug interactions) rises with age. In cases involving a high risk of gastrointestinal complications or concerns about hepatotoxicity, with a low cardiovascular risk, the first-line nonsteroidal anti-inflammatory drugs to consider should be coxibs including etoricoxib.
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Lin HC, Xirasagar S, Lee CZ, Huang CC, Chen CH. The association between gastro-oesophageal reflux disease and subsequent rheumatoid arthritis occurrence: a nested case-control study from Taiwan. BMJ Open 2017; 7:e016667. [PMID: 29151046 PMCID: PMC5702028 DOI: 10.1136/bmjopen-2017-016667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Gastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset. SETTING Taiwan PARTICIPANTS: We used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study patient with GORD). INTERVENTION We tracked each patient's claims over a 5-year period to identify those who subsequently received a diagnosis of RA. Cox proportional hazard (PH) regression modelling was used for analysis. RESULTS Over 5-year follow-up, RA incidence rate per 1000 person-years was 2.81 among patients with GORD and 0.84 among the comparison group. Cox PH modelling showed that GORD was independently associated with a 2.84-fold increased risk of RA (95% CI 2.09 to 3.85) over 5-year follow-up, after adjusting for the number of ambulatory care visits within the year following the index date (to mitigate surveillance bias). CONCLUSIONS We observed that GORD might associate with subsequent RA occurrence. Because current treatment guidelines for RA emphasise early diagnosis and prompt treatment, the observed association between GORD and RA may help acquaint clinicians to patients with GORD with higher RA risk and facilitate early diagnosis and treatment.
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Affiliation(s)
- Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Cha-Ze Lee
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chung-Chien Huang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chao-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Physiology, Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Chen HL, Shen LJ, Hsu PN, Shen CY, Hall SA, Hsiao FY. Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study. J Rheumatol 2017; 45:83-89. [PMID: 29142034 DOI: 10.3899/jrheum.160214] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this population-based study is to examine the adverse events (AE) associated with longitudinal systemic glucocorticoid (GC) use among an ethnic Chinese systemic lupus erythematosus (SLE) cohort. METHODS Our study subjects were patients with newly diagnosed SLE aged 18 and older who received at least 1 prescription of systemic GC between 2001 and 2012 from Taiwan's National Health Insurance Research Database (NHIRD). The earliest prescription date of systemic GC for each subject was defined as the index date. For each subject, we calculated the average prednisolone-equivalent dose and the medication possession ratio (MPR) of GC use every 90 days for each patient after the index date. Patients with a diagnosis of AE (defined by the International Classification of Diseases-9-Clinical Modification diagnosis code) during the followup were also identified from the NHIRD. Generalized estimating equations adjusted for propensity score were applied to examine the association between longitudinal GC use and risks of prespecified AE (musculoskeletal, gastrointestinal, ophthalmologic, infectious, cardiovascular, neuropsychiatric, metabolic, and dermatologic diseases). RESULTS We identified 11,288 patients with SLE (mean followup: 6.28 yrs). Higher doses and higher MPR of GC were associated with increased risk of osteonecrosis [adjusted OR (aOR) 2.87-9.09]. Similar results were found regarding the risk of osteoporosis (aOR 1.71-3.67), bacterial infection (aOR 2.12-3.89), Cushingoid syndrome (aOR 6.51-62.03), and sleep disorder (aOR 1.42-3.59). CONCLUSION To our knowledge, this is the first study to show that the dose and intensity of longitudinal use of GC were both associated with risk of AE among a nationwide Asian SLE cohort.
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Affiliation(s)
- Hung-Lin Chen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Li-Jiuan Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Ping-Ning Hsu
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Chieh-Yu Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Susan A Hall
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Fei-Yuan Hsiao
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA. .,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors.
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A Comparison of Two Dosing Regimens of ASA Following Total Hip and Knee Arthroplasties. J Arthroplasty 2017; 32:S157-S161. [PMID: 28214257 DOI: 10.1016/j.arth.2017.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare short-term side effects of aspirin (ASA) 325 mg vs ASA 81 mg orally twice daily (PO BID) when used as thromboembolic prophylaxis following primary total joint arthroplasty. METHODS A 1-year prospective cohort study was performed on 643 primary unilateral total joint arthroplasty patients operated on by a single surgeon. Two hundred eighty-two patients were administered ASA 325 mg PO BID and 361 patients were administered ASA 81 mg PO BID for 1 month. A questionnaire assessing the side effects of ASA intake was administered 1 month postoperatively. RESULTS The overall rate of gastrointestinal side effects (GI upset and nausea) was 1.9%, but ASA 325 mg had a higher rate 9/282 (3.2%) than ASA 81 mg 3/361 (0.8%), P = .04. Overall GI bleeding was 0.9%, with 2/282 (0.7%) in the ASA 325 mg group, vs 4/361 (1.1%) in the ASA 81 mg group, P = .70. One patient in the ASA 81 mg group (0.3%) developed a deep vein thrombosis. No patient developed pulmonary embolism, periprosthetic joint infection, tinnitus, wheezing and/or shortness of breath, chest pain, or headaches. In the ASA 325 mg group, 9/282 (3.2%) discontinued ASA and in the ASA 81 mg group, 8/361 (2.2%) discontinued ASA, P = .47. Four patients in the ASA 325 group (1.4%) changed to ASA 81 mg. CONCLUSION ASA 81 mg is associated with significantly less GI distress and nausea compared with ASA 325 mg. GI bleeding was equally prevalent between the 2 dosing regimens, so patients need to be informed of this risk regardless of the ASA dose.
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Tacconelli S, Bruno A, Grande R, Ballerini P, Patrignani P. Nonsteroidal anti-inflammatory drugs and cardiovascular safety – translating pharmacological data into clinical readouts. Expert Opin Drug Saf 2017; 16:791-807. [DOI: 10.1080/14740338.2017.1338272] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Stefania Tacconelli
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Annalisa Bruno
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Rosalia Grande
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Patrizia Ballerini
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
- Department of Psychological, Health and Territorial Sciences, ‘G.d’Annunzio’ University, Chieti, Italy
| | - Paola Patrignani
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
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Gaffey A, Slater H, Porritt K, Campbell JM. The effects of curcuminoids on musculoskeletal pain: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:486-516. [PMID: 28178024 DOI: 10.11124/jbisrir-2016-003266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Western countries are increasingly using complementary and alternative medicine (CAM) to assist with relieving ailments. Turmeric, from the ginger family Zingiberaceae, has a history of use for medicinal purposes. The polyphenols found in turmeric (curcuminoids) have demonstrated anti-inflammatory and pain relieving properties. With the use of CAMs increasing, it is important for the effectiveness of curcuminoids to be established. OBJECTIVES To identify the effectiveness of the use of curcuminoids for the amelioration of musculoskeletal pain. INCLUSION CRITERIA TYPES OF PARTICIPANTS Persons experiencing musculoskeletal pain, including experimentally induced musculoskeletal pain. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The current review considered studies that evaluated the use of curcuminoids. TYPES OF CONTROLS Any form including placebo, treatment as usual or before and after measurements. TYPES OF STUDIES Both experimental and epidemiological study designs including randomized controlled trials (RCTs), non-RCTs, quasi-experimental and before and after studies were eligible for consideration in this review. Studies published in English were considered without date restriction. OUTCOMES The current review considered studies that included measurement of pain. Outcome measures included visual analog scales, and/or pain questionnaires. Secondary outcome measures of functionality (activities of daily living and range of motion) were included. Any data provided on adverse events were considered. SEARCH STRATEGY The databases PubMed, CINAHL, Embase and ProQuest were searched in March 2015 (and updated in April 2016) using the Joanna Briggs Institute (JBI) three-step search strategy. The reference lists of identified articles were reviewed for additional studies. METHODOLOGICAL QUALITY Papers selected were assessed by two independent reviewers using standardized instruments from the JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the data extraction tool from JBI-MAStARI. Data extracted included details about the populations, interventions, study methods and outcomes. DATA SYNTHESIS Narrative and tabular synthesis was conducted. Meta-analysis was precluded due to methodological and clinical heterogeneity across all included studies. RESULTS Thirteen studies with a combined total of 1101 participants were included. Three studies of limited sample size examined the effects of curcuminoids compared with the use of placebo on musculoskeletal pain, with one study showing a statistically significant effect. Four studies examined the effects of curcuminoids compared with non-selective non-steroidal anti-inflammatory drugs on musculoskeletal pain. Two of these four studies were non-inferiority studies showed that the use of both curcuminoids and ibuprofen were associated with a similar significant reduction in pain over the study durations of four and six weeks, respectively, with curcuminoid use non-inferior to the use of ibuprofen over the study durations. Six studies investigated presentations of curcuminoid-containing herbomineral mixtures versus placebo or active controls. CONCLUSION There is insufficient evidence to recommend that curcuminoids be considered for relieving pain and improving function in musculoskeletal pain conditions. This finding needs to be considered in the context of limitations imposed by the variability in the quality of studies, small sample sizes, short duration of interventions, a gender-bias toward females, absence of long-term data extraction and small number of relevant studies.
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Affiliation(s)
- Andrew Gaffey
- 1The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia 2School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Denisov LN, Tsvetkova ES, Golubev GS, Bugrova OV, Dydykina IS, Dubikov AI, Menshikova LV, Peshekhonova LK, Rebrov AP, Torgashin AN, Trofimov EA, Yakupova SP, Zonova EV, Brewer O, Cooper C, Reginster J, Knyazeva LA. THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTS. ACTA ACUST UNITED AC 2017. [DOI: 10.14412/1995-4484-2016-641-653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.
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Affiliation(s)
| | | | - G. Sh. Golubev
- Rostov State Medical University, Ministry of Health of Russia
| | - O. V. Bugrova
- Orenburg State Medical University, Ministry of Health of Russia
| | | | - A. I. Dubikov
- Pacific State Medical University, Ministry of Health of Russia
| | | | | | - A. P. Rebrov
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia
| | - A. N. Torgashin
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics, Ministry of Health of Russia
| | - E. A. Trofimov
- I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
| | - S. P. Yakupova
- Kazan State Medical University, Ministry of Health of Russia
| | - E. V. Zonova
- Railway Clinical Hospital at the Novosibirsk-Main Station, OAO «RZhD»
| | - O. Brewer
- Epidemiology, and Health Economics, Centre Hospitalier Universitaire in Sart-Tilman, Universite de Liege
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - J. Reginster
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford
| | - L. A. Knyazeva
- Kursk State Medical University, Ministry of Health of Russia
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Improving the effectiveness of drug safety alerts to increase adherence to the guideline for gastrointestinal prophylaxis. Int J Med Inform 2016; 97:139-144. [PMID: 27919373 DOI: 10.1016/j.ijmedinf.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Gastrointestinal bleedings are the most frequently occurring reason for medication-related hospital admissions, which are potentially preventable. We implemented a clinical decision support system that recommends to prescribe gastrointestinal prophylaxis in patients with an increased risk according to the Dutch guideline. Our primary objective was to determine whether the implementation resulted in improved compliance with this guideline for gastrointestinal prophylaxis. A secondary objective was to determine whether implementation resulted in a reduction of the number of drug safety alerts. MATERIALS AND METHODS This intervention study was performed at the Spaarne Gasthuis, a teaching hospital, using Epic as hospital information system. We selected prescriptions with an indication for gastrointestinal prophylaxis according to the guideline, in the three months before and after implementation of the clinical decision support in November 2014. We analyzed whether gastrointestinal prophylaxis was prescribed more frequently after implementation using the Pearson's Chi-square test and the change in the number of drug safety alerts. RESULTS Before implementation in 84.0% of the included 2064 prescriptions gastrointestinal prophylaxis was co-prescribed. After implementation this percentage increased to 94.5% of the 2269 prescriptions (p<0.001). The number of drug safety alerts decreased by 78.2% from 980 to 217 alerts. CONCLUSION The introduction of a clinical decision support system for gastrointestinal prophylaxis improved adherence to the Dutch guideline. This was most likely due to a reduction in the number of irrelevant drug safety alerts.
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Abstract
Non-steroidal anti-inflammatory drug (NSAID) use increases the risk of gastrointestinal complications such as ulcers or bleeding. The presence of factors like advanced age, history of peptic ulcer, Helicobacter pylori infection and the use of anticoagulants or antiplatelet agents increase this risk further. COX-2 inhibitors and antisecretory drugs, particularly proton pump inhibitors, help to minimize the risk of gastrointestinal complications in high-risk patients. This review presents a practical approach to the prevention and treatment of NSAID-associated peptic ulcer disease and examines the new advances in the rational use of NSAIDs.
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Affiliation(s)
- Luigi Melcarne
- a Unidad de Gastroenterología, Servicio de Digestivo , Corporació Sanitària Parc Taulí , Sabadell , Spain
| | - Pilar García-Iglesias
- a Unidad de Gastroenterología, Servicio de Digestivo , Corporació Sanitària Parc Taulí , Sabadell , Spain
| | - Xavier Calvet
- a Unidad de Gastroenterología, Servicio de Digestivo , Corporació Sanitària Parc Taulí , Sabadell , Spain.,b Departament de Medicina , Universitat Autònoma de Barcelona , Sabadell , Spain.,c CIBERehd , Instituto Carlos III , Madrid , Spain
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Xu L, Liu S, Guan M, Xue Y. Comparison of Prednisolone, Etoricoxib, and Indomethacin in Treatment of Acute Gouty Arthritis: An Open-Label, Randomized, Controlled Trial. Med Sci Monit 2016; 22:810-7. [PMID: 26965791 PMCID: PMC4791088 DOI: 10.12659/msm.895749] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background At present there are several kinds of medicine for treating acute gout arthritis (AGA). This study compared the efficacy and safety of prednisolone, etoricoxib, and indomethacin in the treatment of AGA. Material/Methods This was an open-label, randomized, active-comparator study in patients with AGA. Patients were randomized to 4 days of prednisolone 35 mg qd, etoricoxib 120 mg qd, or indomethacin 50 mg tid. The primary efficacy endpoint was the reduction of self-assessed pain in the index joint from baseline. Secondary endpoints included changes in physician’s assessment of tenderness, erythema, swelling, and joint activity; patient assessment of response to therapy; and safety. Results We analyzed 113 patients. Baseline demographics were comparable among treatment groups. Oral prednisolone, etoricoxib, and indomethacin were similarly effective in improving pain, tenderness, and joint activity over 4 days. For inflammation, oral prednisolone, etoricoxib, and indomethacin were similarly effective in reducing erythema, but prednisolone might be more effective in reducing swelling than indomethacin. The patient response to therapy was similar in the 3 groups. There were more total adverse events with indomethacin compared with the other 2 drugs. Conclusions Efficacy was comparable among prednisolone, etoricoxib, and indomethacin for the treatment of AGA. Prednisolone might be more effective in reducing inflammation and it had a better safety profile.
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Affiliation(s)
- Lingling Xu
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Shiqun Liu
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Meiping Guan
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yaoming Xue
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
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Bruyère O, Cooper C, Pelletier JP, Maheu E, Rannou F, Branco J, Luisa Brandi M, Kanis JA, Altman RD, Hochberg MC, Martel-Pelletier J, Reginster JY. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis—From evidence-based medicine to the real-life setting. Semin Arthritis Rheum 2016; 45:S3-11. [DOI: 10.1016/j.semarthrit.2015.11.010] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 01/27/2023]
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Pelletier JP, Martel-Pelletier J, Rannou F, Cooper C. Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum 2016; 45:S22-7. [DOI: 10.1016/j.semarthrit.2015.11.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022]
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Byun JH, Kwon SH, Lee JE, Cheon JE, Jang EJ, Lee EK. Comparison of benefit-risk preferences of patients and physicians regarding cyclooxygenase-2 inhibitors using discrete choice experiments. Patient Prefer Adherence 2016; 10:641-50. [PMID: 27175064 PMCID: PMC4854248 DOI: 10.2147/ppa.s98228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To elucidate and compare benefit-risk preferences among Korean patients and physicians concerning cyclooxygenase-2 (Cox-2) inhibitor treatments for arthritis. MATERIALS AND METHODS Subjects included 100 patients with arthritis and 60 board-certified orthopedic surgeon physicians in South Korea. Through a systematic review of the literature, beneficial attributes of using Cox-2 inhibitors were defined as a decrease in the Western Ontario and McMaster Universities Arthritis Index for pain score and improvement in physical function. Likewise, risk attributes included upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events. Discrete choice experiments were used to determine preferences for these four attributes among Korean patients and physicians. Relative importance and maximum acceptable risk for improving beneficial attributes were assessed by analyzing the results of the discrete choice experiment by using a conditional logit model. RESULTS Patients ranked the relative importance of benefit-risk attributes as follows: pain reduction (35.2%); physical function improvement (30.0%); fewer CV adverse events (21.5%); fewer GI complications (13.4%). The physicians' ranking for the same attributes was as follows: fewer CV (33.5%); pain reduction (32.4%); fewer GI complications (18.1%); physical function improvement (16.0%). Patients were more willing than physicians to accept risks when pain improved from 20% or 45% to 55% and physical function improved from 15% or 35% to 45%. CONCLUSION We confirmed that patients and physicians had different benefit-risk preferences regarding Cox-2 inhibitors. Patients with arthritis prioritized the benefits of Cox-2 inhibitors over the risks; moreover, in comparison with the physicians, arthritis patients were more willing to accept the trade-off between benefits and risks to achieve the best treatment level. To reduce the preference gap and achieve treatment goals, physicians must better understand their patients' preferences.
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Affiliation(s)
- Ji-Hye Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ji-Eun Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ji-Eun Cheon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Eun-Jin Jang
- Information Statistics, Andong National University, Andong, Gyeongsangbuk-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Correspondence: Eui-Kyung Lee, School of Pharmacy, Sungkyunkwan University, 300 Cheonchoen-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746, South Korea, Tel +82 31 290 7786, Fax +82 31 299 4379, Email
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Risk of gastrointestinal complications associated to NSAIDs, low-dose aspirin and their combinations: Results of a pharmacovigilance reporting system. Pharmacol Res 2015; 104:108-14. [PMID: 26739516 DOI: 10.1016/j.phrs.2015.12.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 01/30/2023]
Abstract
Gastrointestinal (GI) complications are one of the most limiting cause of use of NSAIDs. Beyond others well defined factors, history of peptic ulcer, older age, Helicobacter pylori infection and use of gastrotoxic drugs may affect their GI safety profile. In particular, the risk of GI complications associated to the use of antiplatelet drugs, especially low-dose acetylsalicylic acid (LDA) should deserve much attention. However, only few studies have focused on the effect of combination LDA/NSAIDs on the GI tract compared with the monotherapy and much less studies assessed this effect with multiple NSAIDs use. We aimed to characterize the GI safety profile of NSAIDs and LDA as monotherapy or their combinations in real-life conditions by analysing spontaneous adverse drug reactions (ADRs) reporting system in a Southern Italy. We used the case/non-case method in the Italian Pharmacovigilance Network (RNF). Cases were reports of GI events in the RNF between January 2007 and December 2011. Non-cases were all other reports during the same period. The association between NSAID and suspected GI ADRs was calculated using the reporting odds ratio (ROR) with 95% confidence intervals as a measure of disproportionality while adjusting for age, and concomitant use of antineoplastic agents or drugs for cardiovascular diseases. Sub-analysis were performed within the NSAID class. Among the 2816 adverse drug reactions recorded, we identified 374 (13.3%) cases of GI complications. Upper GI complications were the most frequently reported type of events. The highest associations were found for the combined use of NSAIDs and/or LDA, whilst the lowest associations were for their respective monotherapy. Looking at individual NSAIDs the highest association with GI events was observed for ketorolac exposure followed by nimesulide, diclofenac, aspirin, ketoprofen, and ibuprofen. This study highlights the primary role of the national spontaneous reporting system to bring out potential signals, such as the inappropriate drug use pattern, which however, have to be furtherly studied in-depth with ad hoc population-based studies.
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Tielleman T, Bujanda D, Cryer B. Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:415-28. [PMID: 26142028 DOI: 10.1016/j.giec.2015.02.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although the incidence of nonvariceal upper gastrointestinal bleeding (UGIB) has been decreasing worldwide, nonvariceal UGIB continues to be a significant problem. Even with the advent of advanced endoscopic procedures and potent medications to suppress acid production, UGIB carries significant morbidity and mortality. Some of the most common risk factors for nonvariceal UGIB include Helicobacter pylori infection, nonsteroidal antiinflammatory drugs (NSAIDs), aspirin, selective serotonin reuptake inhibitors, and other antiplatelet and anticoagulant medications. In patients with cardiovascular disease and kidney disease, UGIB tends to be more severe and has greater morbidity. Many of the newer NSAIDs have been removed from the market.
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Affiliation(s)
- Thomas Tielleman
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Daniel Bujanda
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Byron Cryer
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390, USA; Medical Service, Gastroenterology Section 111B1, Dallas VA Medical Center, 4500 S Lancaster Road, Dallas, TX 75216, USA.
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Richette P, Latourte A, Frazier A. Safety and efficacy of paracetamol and NSAIDs in osteoarthritis: which drug to recommend? Expert Opin Drug Saf 2015; 14:1259-68. [PMID: 26134750 DOI: 10.1517/14740338.2015.1056776] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is the most common form of arthritis and is a major cause of disability, especially in people ≥ 45 years old. Several international societies recommend the use of both acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate OA pain. However, patients with OA often have comorbidities, notably cardiovascular risk factors, which may hamper the use of these analgesics. AREAS COVERED This paper reviews the safety of both acetaminophen and NSAIDs in OA. Recent data have pointed to a gastrointestinal and cardiovascular toxicity of acetaminophen, which has been neglected for a long time. In addition, several meta-analyses revealed that acetaminophen is a poor analgesic in OA. Traditional NSAIDs and cyclooxygenase 2 inhibitors (coxibs) have similar analgesic effects but vary greatly in their potential gastrointestinal and cardiovascular toxicity. EXPERT OPINION Given the putative gastrointestinal and cardiovascular toxicity and poor analgesic properties of acetaminophen in OA, its use in patients with risk factors is questionable. Acetaminophen should be used at the lowest effective dosage and for the shortest time in all OA patients. Given the different safety profiles, the choice of NSAIDs, traditional or coxibs, should be based on individual patient risk factors. A good knowledge of the different strategies to decrease the gastrointestinal and cardiovascular toxic effects of NSAIDs is key to the management of OA.
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Affiliation(s)
- Pascal Richette
- Université Paris Diderot, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie , 75475 Paris Cedex 10 , France
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Goldstein JL, Cryer B. Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:31-41. [PMID: 25653559 PMCID: PMC4310346 DOI: 10.2147/dhps.s71976] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective anti-inflammatory and analgesic agents and are among the most commonly used classes of medications worldwide. However, their use has been associated with potentially serious dose-dependent gastrointestinal (GI) complications such as upper GI bleeding. GI complications resulting from NSAID use are among the most common drug side effects in the United States, due to the widespread use of NSAIDs. The risk of upper GI complications can occur even with short-term NSAID use, and the rate of events is linear over time with continued use. Although gastroprotective therapies are available, they are underused, and patient and physician awareness and recognition of some of the factors influencing the development of NSAID-related upper GI complications are limited. Herein, we present a case report of a patient experiencing a gastric ulcer following NSAID use and examine some of the risk factors and potential strategies for prevention of upper GI mucosal injuries and associated bleeding following NSAID use. These risk factors include advanced age, previous history of GI injury, and concurrent use of medications such as anticoagulants, aspirin, corticosteroids, and selective serotonin reuptake inhibitors. Strategies for prevention of GI injuries include anti-secretory agents, gastroprotective agents, alternative NSAID formulations, and nonpharmacologic therapies. Greater awareness of the risk factors and potential therapies for GI complications resulting from NSAID use could help improve outcomes for patients requiring NSAID treatment.
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Affiliation(s)
- Jay L Goldstein
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Byron Cryer
- Division of Gastroenterology, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, TX, USA
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van der Goes MC, Jacobs JW, Bijlsma JW. The value of glucocorticoid co-therapy in different rheumatic diseases--positive and adverse effects. Arthritis Res Ther 2014; 16 Suppl 2:S2. [PMID: 25608693 PMCID: PMC4249491 DOI: 10.1186/ar4686] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glucocorticoids play a pivotal role in the management of many inflammatory rheumatic diseases. The therapeutic effects range from pain relief in arthritides, to disease-modifying effects in early rheumatoid arthritis, and to strong immunosuppressive actions in vasculitides and systemic lupus erythematosus. There are multiple indications that adverse effects are more frequent with the longer use of glucocorticoids and use of higher dosages, but high-quality data on the occurrence of adverse effects are scarce especially for dosages above 10 mg prednisone daily. The underlying rheumatic disease, disease activity, risk factors and individual responsiveness of the patient should guide treatment decisions. Monitoring for adverse effects should also be tailored to the patient. Continuously balancing the benefits and risks of glucocorticoid therapy is recommended. There is an ongoing quest for new drugs with glucocorticoid actions without the potential to cause harmful effects, such as selective glucocorticoid receptor agonists, but the application of a new compound in clinical practice will probably not occur within the next few years. In the meantime, basic research on glucocorticoid effects and detailed reports on therapeutic efficacy and occurrence of adverse effects will be valuable in weighing benefits and risks in clinical practice.
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