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Kim JB, Kim Y, Kim SJ, Ha TY, Kim DK, Kim DW, So M, Kim SH, Woo HG, Yoon D, Park SM. Integration of National Health Insurance claims data and animal models reveals fexofenadine as a promising repurposed drug for Parkinson's disease. J Neuroinflammation 2024; 21:53. [PMID: 38383441 PMCID: PMC10880337 DOI: 10.1186/s12974-024-03041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a common and costly progressive neurodegenerative disease of unclear etiology. A disease-modifying approach that can directly stop or slow its progression remains a major unmet need in the treatment of PD. A clinical pharmacology-based drug repositioning strategy is a useful approach for identifying new drugs for PD. METHODS We analyzed claims data obtained from the National Health Insurance Service (NHIS), which covers a significant portion of the South Korean population, to investigate the association between antihistamines, a class of drugs commonly used to treat allergic symptoms by blocking H1 receptor, and PD in a real-world setting. Additionally, we validated this model using various animal models of PD such as the 6-hydroxydopmaine (6-OHDA), α-synuclein preformed fibrils (PFF) injection, and Caenorhabditis elegans (C. elegans) models. Finally, whole transcriptome data and Ingenuity Pathway Analysis (IPA) were used to elucidate drug mechanism pathways. RESULTS We identified fexofenadine as the most promising candidate using National Health Insurance claims data in the real world. In several animal models, including the 6-OHDA, PFF injection, and C. elegans models, fexofenadine ameliorated PD-related pathologies. RNA-seq analysis and the subsequent experiments suggested that fexofenadine is effective in PD via inhibition of peripheral immune cell infiltration into the brain. CONCLUSION Fexofenadine shows promise for the treatment of PD, identified through clinical data and validated in diverse animal models. This combined clinical and preclinical approach offers valuable insights for developing novel PD therapeutics.
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Affiliation(s)
- Jae-Bong Kim
- Department of Pharmacology, Ajou University School of Medicine, 164, Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Korea
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Yujeong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Jeong Kim
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
| | - Tae-Young Ha
- Department of Pharmacology, Ajou University School of Medicine, 164, Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Korea
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
- Neuroscience Research Institute, Gachon University, Incheon, Korea
| | - Dong-Kyu Kim
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
| | - Dong Won Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | | | - Seung Ho Kim
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Goo Woo
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
| | - Sang Myun Park
- Department of Pharmacology, Ajou University School of Medicine, 164, Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Korea.
- Center for Convergence Research of Neurological Disorders, Ajou University School of Medicine, Suwon, Korea.
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea.
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Zhang M, Ao T, Cheng L. Highlights of the treatment of allergic rhinitis according to Chinese guidelines. Curr Opin Allergy Clin Immunol 2023; 23:334-340. [PMID: 37357787 DOI: 10.1097/aci.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines. RECENT FINDINGS Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients. SUMMARY This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.
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Affiliation(s)
- Min Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Tian Ao
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Gómez RM, Moreno P, Compalati E, Canonica GW, Ansotegui Zubeldia IJ. Update meta-analysis on the efficacy and safety issues of fexofenadine. World Allergy Organ J 2023; 16:100795. [PMID: 37546236 PMCID: PMC10401337 DOI: 10.1016/j.waojou.2023.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Background Fexofenadine emerged as one of the most representative second generation histamine H1 antagonist drugs since the 1990s, with an outstanding efficacy and appreciable safety for the treatment of allergic patients. While allergic rhino-conjunctivitis represents the most frequent atopic disease globally, an update of fexofenadine efficacy and safety on this entity was proposed as a surrogate of allergic condition. Methods Double blind, placebo controlled, randomized clinical trials investigating the efficacy and safety of fexofenadine for the treatment of Allergic Rhinitis were searched in 5 major global databases. Eligibility criteria and characteristics, risk of bias, and validity assessment, data extraction and heterogeneity evaluation are described. Primary outcome selected corresponded to 12-reflective and instantaneous total symptom scores (TSS), besides morning instantaneous TSS and the frequency of reported adverse events (AEs); analysis was planned on the intention-to-treat population.Standardized mean differences of scoring systems were analyzed, and Cochran's Q statistic test and the I2 test were assessed for heterogeneity. Results From the initial 83 identified records, 12 eligible studies were selected. In the evaluated patients, individuals receiving fexofenadine (1910) showed a significant reduction of TSS compared with those who received placebo (1777), change from baseline: standardized mean difference (SMD) -0.33; 95% CI-0.47 to -0.18, p < 0.0001. Morning instantaneous TSS also demonstrated lower symptoms (change from baseline: SMS -1.42; 95% CI -2.22 to -0.62, p = 0.0005). Heterogeneity was found across selected studies.Frequency of AEs was similar compared to placebo (OR = 1.04; 0.88-1.21), with no detection of heterogeneity across these 12 studies. Conclusions According to this new evidence, fexofenadine maintains its beneficial profile on signs and symptoms of patients with allergic conditions, as well as its attributes as one of the major candidates for an ideal antihistamine medication (including special conditions such as pregnancy and pre-school age), providing support to its over-the-counter condition in several countries.
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Affiliation(s)
- René Maximiliano Gómez
- Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Argentina
- Ayre Foundation, Salta, Argentina
| | - Pablo Moreno
- Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Argentina
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Asthma & Allergy Unit-IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy
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D'Amato G, Murrieta-Aguttes M, D'Amato M, Ansotegui IJ. Pollen respiratory allergy: Is it really seasonal? World Allergy Organ J 2023; 16:100799. [PMID: 37520612 PMCID: PMC10384659 DOI: 10.1016/j.waojou.2023.100799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Allergic rhinitis (AR) is a highly prevalent respiratory condition that carries a heavy burden and can have a significant impact on patient quality of life. AR is caused by seasonal or perennial exposure to outdoor pollens and molds as well as indoor allergic triggers. In this review article, we discuss the factors associated with the development of AR throughout the year and the fact that patients with AR need continuous treatment rather than seasonal treatment. Conventionally, AR has been mainly categorized into seasonal AR and perennial AR, but these classes do not seem to be well-adapted. Climate changes, temperature changes, and high carbon dioxide (CO2) concentration affect the growth of plants and increase the length of pollen seasons and pollen allergenicity. Air pollution aggravates allergic sensitization symptoms in AR sensitized individuals. Due to increased air pollution and indefinite pollen seasons AR symptoms are present throughout the year. Patients with AR often need continuous treatment, which should be considered while making the strategy for treating allergic rhinitis sufferers. Management of AR involves avoiding the allergen, medications for symptomatic relief, anti-inflammatory therapies, and allergy immunotherapy. Although the first-generation H1-antihistamines reduce AR symptoms, they cause sedation and impair cognitive functions; thus, second-generation antihistamines (ie, levocetirizine, loratadine, bilastine, fexofenadine) are preferred. The efficacy and safety of fexofenadine for the treatment of seasonal allergic rhinitis (SAR) symptoms have been demonstrated by numerous clinical studies, irrespective of the season and underlying allergen. In this review, we discuss the allergic rhinitis classification, the role of climate change, air pollution, and factors contributing to year-round symptoms in patients with AR and the need for continuous pharmacological treatment for management.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty A. Cardarelli Hospital, University of Naples Federico II, Napoli, Italy
| | | | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
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Kavya R, Kala A, Christopher J, Panda S, Lazarus B. DAAR: Drift Adaption and Alternatives Ranking approach for interpretable clinical decision support systems. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Pang JC, Vasudev M, Du AT, Nottoli MM, Dang K, Kuan EC. Intranasal Anticholinergics for Treatment of Chronic Rhinitis: Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:722-731. [PMID: 35838014 DOI: 10.1002/lary.30306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non-allergic rhinitis symptom severity and duration. METHODS A search encompassing the Cochrane Library, PubMed/MEDLINE, and Scopus databases was conducted. Primary studies describing rhinorrhea, nasal congestion, and/or postnasal drip outcomes in rhinitis patients treated with an anticholinergic spray were included for review. RESULTS The search yielded 1,029 unique abstracts, of which 12 studies (n = 2,024) met inclusion criteria for qualitative synthesis and 9 (n = 1,920) for meta-analysis. Median follow-up was 4 weeks and ipratropium bromide was the most extensively trialed anticholinergic. Compared to placebo, anticholinergic treatment was demonstrated to significantly reduce rhinorrhea severity scores (standardized mean difference [95% CI] = -0.77 [-1.20, -0.35]; -0.43 [-0.72, -0.13]) and duration (-0.62 [-0.95, -0.30]; -0.29 [-0.47, -0.10]) in allergic and non-allergic rhinitis patients respectively. Benefit was less consistent for nasal congestion, postnasal drip, and sneezing symptoms. Reported adverse effects included nasal mucosa dryness or irritation, epistaxis, headaches, and pharyngitis, though comparison to placebo found significantly greater risk for epistaxis only (risk ratio [95% CI] = 2.19 [1.22, 3.93]). CONCLUSION Albeit treating other symptoms with less benefit, anticholinergic nasal sprays appear to be safe and efficacious in reducing rhinorrhea severity and duration in both rhinitis etiologies. This evidence supports their continued use in the treatment of rhinitis-associated rhinorrhea. LEVEL OF EVIDENCE 1 Laryngoscope, 133:722-731, 2023.
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Affiliation(s)
- Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Amy T Du
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Madeline M Nottoli
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Katherine Dang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Correction: Fexofenadine: review of safety, efficacy and unmet needs in children with allergic rhinitis. Allergy Asthma Clin Immunol 2022; 18:112. [PMID: 36575521 PMCID: PMC9793548 DOI: 10.1186/s13223-022-00754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
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Ramisetty K, Christopher J, Panda S, Lazarus BS, Dayalan J. An Explainable Knowledge-Based System Using Subjective Preferences and Objective Data for Ranking Decision Alternatives. Methods Inf Med 2022; 61:111-122. [PMID: 36220110 DOI: 10.1055/s-0042-1756650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Allergy is a hypersensitive reaction that occurs when the allergen reacts with the immune system. The prevalence and severity of the allergies are uprising in South Asian countries. Allergy often occurs in combinations which becomes difficult for physicians to diagnose. OBJECTIVES This work aims to develop a decision-making model which aids physicians in diagnosing allergy comorbidities. The model intends to not only provide rational decisions, but also explainable knowledge about all alternatives. METHODS The allergy data gathered from real-time sources contain a smaller number of samples for comorbidities. Decision-making model applies three sampling strategies, namely, ideal, single, and complete, to balance the data. Bayes theorem-based probabilistic approaches are used to extract knowledge from the balanced data. Preference weights for attributes with respect to alternatives are gathered from a group of domain-experts affiliated to different allergy testing centers. The weights are combined with objective knowledge to assign confidence values to alternatives. The system provides these values along with explanations to aid decision-makers in choosing an optimal decision. RESULTS Metrics of explainability and user satisfaction are used to evaluate the effectiveness of the system in real-time diagnosis. Fleiss' Kappa statistic is 0.48, and hence the diagnosis of experts is said to be in moderate agreement. The decision-making model provides a maximum of 10 suitable and relevant pieces of evidence to explain a decision alternative. Clinicians have improved their diagnostic performance by 3% after using CDSS (77.93%) with a decrease in 20% of time taken. CONCLUSION The performance of less-experienced clinicians has improved with the support of an explainable decision-making model. The code for the framework with all intermediate results is available at https://github.com/kavya6697/Allergy-PT.git.
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Affiliation(s)
- Kavya Ramisetty
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | - Jabez Christopher
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | - Subhrakanta Panda
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | | | - Julie Dayalan
- Good Samaritan Kilpauk Lab and Allergy Testing Centre, Chennai, Tamil Nadu, India
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