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Sinha SD, Perapogu S, Chary S S, Ramesh S, Bakshi J, Singh A, Ahmed AK, Mohan Reddy B, Panapakam M, Talluri L, Vattipalli R. Efficacy and safety of fixed-dose combination of Bilastine-Montelukast in adult patients with allergic rhinitis: a phase III, randomized, multi-center, double-blind, active controlled clinical study. J Asthma 2023; 60:2014-2020. [PMID: 37140964 DOI: 10.1080/02770903.2023.2209175] [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: 01/31/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Histamine and cysteinyl leukotrienes (CysLTs) are potent inflammatory mediators in allergic rhinitis (AR). Studies involving other combinations of antihistaminics (Levocetirizine) and highly selective leukotriene receptor antagonist (LTA) (Montelukast) combination have shown additive benefits and are widely prescribed for AR. OBJECTIVE Evaluate the efficacy and safety of Bilastine 20 mg and Montelukast 10 mg fixed-dose combination (FDC) therapy in patients with AR. METHODS A randomized, double-blind, comparative, parallel, phase III study was conducted to evaluate efficacy and safety of Bilastine 20 mg and Montelukast 10 mg FDC at 16 tertiary care otolaryngology centres in India. Adult patients with AR for one year with IgE antibody positive and 12-h NSS score >36 in 3 days were randomized to receive either Bilastine 20 mg and Montelukast 10 mg or Montelukast 10 mg & Levocetirizine 5 mg tablets for 4 weeks. The change in total symptom score (nasal symptom scores (NSS) & non-nasal symptom scores (NNSS)) from baseline to week 4 was assessed as primary endpoint. Secondary endpoints included changes in TSS, NSS, NNSS, individual symptom scores (ISS), Rhinoconjunctivitis Quality of Life (RQLQ), discomfort due to rhinitis (VAS), and clinical global impression (CGI) scores. RESULTS The change in mean TSS from baseline to week 4 in Test group (16.6 units) was comparable to reference group (17 units) (p= 0.8876). The difference in change in mean NSS, NNSS and ISS from baseline to day 7, 14, 28 were comparable. RQLQ improved from baseline to Day 28. Significant improvements were observed in discomfort due to AR measured by VAS and CGI scores from baseline to day 14 and 28. The safety and tolerability of patients were comparable between the groups. All adverse events (AEs) were mild to moderate in severity. No patient discontinued due to AEs. CONCLUSIONS The FDC of Bilastine 20 mg and Montelukast 10 mg was efficacious and well tolerated in Indian patients with AR.
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Affiliation(s)
- Shubhadeep D Sinha
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
| | - Sridevi Perapogu
- Department of ENT, Government Medical College & Hospital, SPSR, Nellore, Andhra Pradesh, India
| | - Sreenivasa Chary S
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
| | - S Ramesh
- Department of ENT, Govt Medical College & Govt General Hospital, Srikakulam, Andhra Pradesh, India
| | - Jaimanti Bakshi
- Department of ENT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Singh
- Division of Allergy & Pulmonary Medicine, Dhanvantri OPD Block, SMS Hospital, Jaipur, Rajasthan, India
| | | | - B Mohan Reddy
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
| | - Muralidhar Panapakam
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
| | - Leela Talluri
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
| | - Ramya Vattipalli
- Department of Clinical Development & Medical Affairs, Hetero, Hyderabad, Telengana, India
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Ren EC, Zhuo NZ, Goh ZY, Bonne I, Malleret B, Ko HL. cccDNA-Targeted Drug Screen Reveals a Class of Antihistamines as Suppressors of HBV Genome Levels. Biomolecules 2023; 13:1438. [PMID: 37892121 PMCID: PMC10604930 DOI: 10.3390/biom13101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic infection with hepatitis B virus (HBV) is incurable, as the current therapeutics cannot eliminate its persistent genomic material, cccDNA. Screening systems for cccDNA-targeting therapeutics are unavailable, as low copies of cccDNA in vitro complicate detection. To address this, cccDNA copies were massively increased to levels detectable via automated plate readers. This was achieved via continuous infection in a contact-free co-culture of an HBV generator (clone F881), which stably produced clinically relevant amounts of HBV, and HBV acceptors selected to carry high cccDNA loads. cccDNA-targeted therapeutics were then identified via reduced cccDNA-specific fluorescence, taking differences in the cell numbers and viability into account. Amongst the drugs tested, the H1 antihistamine Bilastine, HBVCP inhibitors and, surprisingly, current HBV therapeutics downregulated the cccDNA significantly, reflecting the assay's accuracy and sensitivity in identifying drugs that induce subtle changes in cccDNA levels, which take years to manifest in vivo. Bilastine was the only therapeutic that did not reduce HBV production from F881, indicating it to be a novel direct suppressor of cccDNA levels. When further assessed, only the structurally similar antihistamines Pitolisant and Nizatidine suppressed cccDNA levels when other H1 antihistamines could not. Taken together, our rapid fluorescence cccDNA-targeted drug screen successfully identified a class of molecules with the potential to treat hepatitis B.
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Affiliation(s)
- Ee Chee Ren
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos, #03-06, Singapore 138648, Singapore; (N.Z.Z.); (Z.Y.G.); (B.M.)
- Immunology Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Block MD4, Level 3, Singapore 117545, Singapore;
| | - Nicole Ziyi Zhuo
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos, #03-06, Singapore 138648, Singapore; (N.Z.Z.); (Z.Y.G.); (B.M.)
| | - Zhi Yi Goh
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos, #03-06, Singapore 138648, Singapore; (N.Z.Z.); (Z.Y.G.); (B.M.)
- Immunology Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Block MD4, Level 3, Singapore 117545, Singapore;
| | - Isabelle Bonne
- Immunology Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Block MD4, Level 3, Singapore 117545, Singapore;
- Electron Microscopy Unit, Yong Loo Lin School of Medicine, National University of Singapore, MD1, Tahir Foundation Building, #B1-01, 12 Science Drive 2, Singapore 117549, Singapore
- Immunology Programme, Life Sciences Institute, Center for Life Sciences, National University of Singapore, #05-02, 28 Medical Drive, Singapore 117456, Singapore
| | - Benoît Malleret
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos, #03-06, Singapore 138648, Singapore; (N.Z.Z.); (Z.Y.G.); (B.M.)
- Immunology Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Block MD4, Level 3, Singapore 117545, Singapore;
- Electron Microscopy Unit, Yong Loo Lin School of Medicine, National University of Singapore, MD1, Tahir Foundation Building, #B1-01, 12 Science Drive 2, Singapore 117549, Singapore
| | - Hui Ling Ko
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos, #03-06, Singapore 138648, Singapore; (N.Z.Z.); (Z.Y.G.); (B.M.)
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Abdelshafy AM, Abdallah SY, Hassan AF, Mohamed HA, Kamal NM, Ali ST, Abdelhaleem IA. The Impact of Bilastine on Symptoms of Allergic Rhinitis and Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Rhinol Allergy 2022; 36:684-694. [PMID: 35593100 DOI: 10.1177/19458924221097449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Allergic diseases are immunological exaggerations with symptoms that may interfere with life quality. Bilastine, a novel oral second-generation H-1 antihistamine, is highly selective to H-1 receptors and has anti inflammatory properties. The present evidence regarding the drug efficacy is inconsistent. OBJECTIVES We aimed to evaluate the efficacy and safety of bilastine compared with the placebo and other active antihistamines in patients who complained either from AR or chronic urticaria. METHODS We systematically searched the Medline, Scopus, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) evaluating bilastine effects on symptomatic hyper histaminic allergic conditions. We collected data on total symptoms scores (TSS), total nasal symptom scores (TNSS), discomfort associated with these allergic conditions measured by visual analog score (VAS), and quality of life (QOL) for AR and urticaria. Other outcomes such as clinical global impression and safety profiles were reported as well. We pooled the studies in a random effect model using RevMan 5.4 software. RESULTS We included 9 RCTs comprising 3801 participants. The meta-analysis revealed that bilastine was superior to placebo, improving TSS, TNSS, VAS, and QOL in AR or chronic urticaria participants. Moreover, the bilastine was comparable to active antihistamines such as cetirizine, fexofenadine, and loratadine regarding mentioned outcomes. In addition, the novel drug was safe and tolerable with no difference in the incidence of adverse events with a placebo. CONCLUSIONS Bilastine safely improved TSS in hyper histaminic allergic conditions involving nasal symptoms in AR. It decreases the discomfort associated with the disease resulting in improving the QOL of the participants.
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Affiliation(s)
- Aliaa M Abdelshafy
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Sara Y Abdallah
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Ahmed F Hassan
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Hazem A Mohamed
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Nourhan M Kamal
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt.,68103Ministry of Health and Population, Cairo, Egypt
| | - Sohila T Ali
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Ibrahim A Abdelhaleem
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
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Rodríguez Del Río P, Rodríguez Fernández F, Ballester Asensio E, Tortajada-Girbés M. How bilastine is used to treat allergic rhinitis and urticaria in children. Immunotherapy 2021; 14:77-89. [PMID: 34850647 DOI: 10.2217/imt-2021-0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Management guidelines for allergic rhinitis and urticaria recommend oral second-generation antihistamines as first-line treatment. The efficacy and safety of bilastine, the newest nonsedating second-generation antihistamine, are well established in adolescents/adults with these allergic conditions. The bilastine development program for pediatric use (2-<12 years) followed EMA-authorized processes. Pharmacokinetic/pharmacodynamic simulation and modeling and a pharmacokinetic study were conducted to identify and confirm the pediatric dose (10 mg/day). A Phase III, multicenter, double-blind, randomized, placebo-controlled, parallel-group study was performed to confirm the safety of bilastine 10 mg/day in children. In this article, evidence is reviewed for use of bilastine in children with allergic rhinoconjunctivitis or urticaria. Several cases are presented which demonstrate its role in routine clinical practice.
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Affiliation(s)
| | | | - Esther Ballester Asensio
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain
| | - Miguel Tortajada-Girbés
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain.,IVI Foundation, Valencia, 46026, Spain
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Falkenstein M, Elek M, Stark H. Chemical Probes for Histamine Receptor Subtypes. Curr Top Behav Neurosci 2021; 59:29-76. [PMID: 34595743 DOI: 10.1007/7854_2021_254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ligands with different properties and different selectivity are highly needed for in vitro and in vivo studies on the (patho)physiological influence of the chemical mediator histamine and its receptor subtypes. A selection of well-described ligands for the different receptor subtypes and different studies is shown with a particular focus on affinity and selectivity. In addition, compounds with radioactive or fluorescence elements will be presented with their beneficial use for other species or different investigations.
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Affiliation(s)
- Markus Falkenstein
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Milica Elek
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Holger Stark
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany.
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Ghoshal T, Patel TM, Kotturi S. Acetic Acid Mediated Electrochemical Synthesis of Benzazole and its Application in the Synthesis of Pharmaceutically Active Compounds. ChemistrySelect 2021. [DOI: 10.1002/slct.202102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tanay Ghoshal
- Shri MM Patel Institute of Sciences and research Department of chemistry, Kadi Sarva Vishwavidyalaya, Gandhinagar- 382024 Gujarat India
- Piramal Discovery Solutions Pharmaceutical Special Economic Zone, Sarkhej Bavla Highway, Ahmedabad Gujarat 382213 India
| | - Tarun M. Patel
- Shri MM Patel Institute of Sciences and research Department of chemistry, Kadi Sarva Vishwavidyalaya, Gandhinagar- 382024 Gujarat India
| | - Sharadsrikar Kotturi
- Piramal Discovery Solutions Pharmaceutical Special Economic Zone, Sarkhej Bavla Highway, Ahmedabad Gujarat 382213 India
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7
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Singh RB, Liu L, Yung A, Anchouche S, Mittal SK, Blanco T, Dohlman TH, Yin J, Dana R. Ocular redness - II: Progress in development of therapeutics for the management of conjunctival hyperemia. Ocul Surf 2021; 21:66-77. [PMID: 34000363 DOI: 10.1016/j.jtos.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Conjunctival hyperemia is one of the most common causes for visits to primary care physicians, optometrists, ophthalmologists, and emergency rooms. Despite its high incidence, the treatment options for patients with conjunctival hyperemia are restricted to over-the-counter drugs that provide symptomatic relief due to short duration of action, tachyphylaxis and rebound redness. As our understanding of the immunopathological pathways causing conjunctival hyperemia expands, newer therapeutic targets are being discovered. These insights have also contributed to the development of animal models for mimicking the pathogenic changes in microvasculature causing hyperemia. Furthermore, this progress has catalyzed the development of novel therapeutics that provide efficacious, long-term relief from conjunctival hyperemia with minimal adverse effects.
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Affiliation(s)
- Rohan Bir Singh
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lingjia Liu
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ann Yung
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sonia Anchouche
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sharad K Mittal
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tomas Blanco
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Design, Synthesis and Anticancer Activity of New Polycyclic: Imidazole, Thiazine, Oxathiine, Pyrrolo-Quinoxaline and Thienotriazolopyrimidine Derivatives. Molecules 2021; 26:molecules26072031. [PMID: 33918322 PMCID: PMC8038178 DOI: 10.3390/molecules26072031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
In this article, we showed the synthesis of new polycyclic aromatic compounds, such as thienotriazolopyrimidinones, N-(thienotriazolopyrimidine) acetamide, 2-mercapto-thienotriazolo-pyrimidinones, 2-(((thieno-triazolopyrimidine) methyl) thio) thieno-triazolopyrimidines, thieno-pyrimidotriazolo-thiazines, pyrrolo-triazolo-thienopyrimidines, thienopyrimido-triazolopyrrolo-quinoxalines, thienopyrimido-triazolo-pyrrolo-oxathiino-quinoxalinones, 1,4-oxathiino-pyrrolo- triazolothienopyrimidinones, imidazopyrrolotriazolothienopyrimidines and 1,2,4-triazoloimidazo- pyrrolotriazolothienopyrimidindiones, based on the starting material 2,3-diamino-6-benzoyl-5- methylthieno[2,3-d]pyrimidin-4(3H)-one (3). The chemical structures were confirmed using many spectroscopic ways (IR, 1H, 13C, −NMR and MS) and elemental analyses. A series of thiazine, imidazole, pyrrole, thienotriazolopyrimidine derivatives were synthesized and evaluated for their antiproliferative activity against four human cancer cell lines, i.e., CNE2 (nasopharyngeal), KB (oral), MCF-7 (breast) and MGC-803 (gastric) carcinoma cells. The compounds 20, 19, 17, 16 and 11 showed significant cytotoxicity against types of human cancer cell lines.
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Abstract
The knowledge about the solid forms landscape of Bilastine (BL) has been extended. The crystal structures of two anhydrous forms have been determined, and the relative thermodynamic stability among the three known anhydrous polymorphs has been established. Moreover, three chloroform solvates with variable stoichiometry have been identified and characterized, showing that S3CHCl3-H2O and SCHCl3 can be classified as transient solvates which transform into the new chloroform solvate SCHCl3-H2O when removed from the mother liquor. The determination of their crystal structures from combined single crystal/synchrotron X-ray powder diffraction data has allowed the complete characterization of these solvates, being two of them heterosolvates (S3CHCl3-H2O and SCHCl3-H2O) and SCHCl3 a monosolvate. Moreover, the temperature dependent stability and interrelation pathways among the chloroform solvates and the anhydrous forms of BL have been studied.
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Choudhary S, Arora M, Verma H, Kumar M, Silakari O. Benzimidazole based hybrids against complex diseases: A catalogue of the SAR profile. Eur J Pharmacol 2021; 899:174027. [PMID: 33731294 DOI: 10.1016/j.ejphar.2021.174027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
The fused heterocyclic ring system has been recognized as a privileged structure that is used as a template in medicinal chemistry for drug discovery. Benzimidazole is one of the common scaffolds found in several natural products such as histidine, purines, and an integral part of vitamin B12. This hetero-aromatic bicyclic ring system acts as a pharmacophore in various drugs of therapeutic interest and has a broad spectrum of activity. Literature reports suggest that diversely substituted benzimidazoles possess distinct pharmacological profiles with multi-targeting potential, thereby, an indispensable anchor for the development of novel therapeutic agents against complex diseases such as cancer, malaria, inflammatory disorders, microbial diseases, hypertension, etc. Thus, lots of efforts have been diverted towards exploring the therapeutic potential of benzimidazoles. Despite great efforts made by the research community, still, some multi-factorial diseases continue to progress due to their complex pathophysiology. Under these sets of circumstances, there is a need to explore this nucleus for hybrid designing with multi-targeting potential against complex diseases. Benzimidazole-based hybrids have been reported to treat multifactorial diseases, making it a scaffold of interest for various pharmaceutical companies and research groups. In this write-up, we shed light on the recent pharmacological profiles, various designing strategies, and structure-activity relationships (SAR) of different benzimidazole-based hybrids.
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Affiliation(s)
- Shalki Choudhary
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India
| | - Mohit Arora
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India
| | - Himanshu Verma
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India
| | - Manoj Kumar
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India
| | - Om Silakari
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India.
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Bo S, Sedaghat F, Pavuluri K, Rowe SP, Cohen A, Kates M, McMahon MT. Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction. Tomography 2021; 7:80-94. [PMID: 33801533 PMCID: PMC8103243 DOI: 10.3390/tomography7010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023] Open
Abstract
Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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Affiliation(s)
- Shaowei Bo
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - KowsalyaDevi Pavuluri
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Andrew Cohen
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Michael T. McMahon
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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Differential Regulation of Bilastine Affinity for Human Histamine H 1 Receptors by Lys 179 and Lys 191 via Its Binding Enthalpy and Entropy. Int J Mol Sci 2021; 22:ijms22041655. [PMID: 33562121 PMCID: PMC7915449 DOI: 10.3390/ijms22041655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Bilastine, a zwitterionic second-generation antihistamine containing a carboxyl group, has higher selectivity for H1 receptors than first-generation antihistamines. Ligand-receptor docking simulations have suggested that the electrostatic interaction between the carboxyl group of second-generation antihistamines and the amino group of Lys179ECL2 and Lys1915.39 of human H1 receptors might contribute to increased affinity of these antihistamines to H1 receptors. In this study, we evaluated the roles of Lys179ECL2 and Lys1915.39 in regulating the electrostatic and hydrophobic binding of bilastine to H1 receptors by thermodynamic analyses. The binding enthalpy and entropy of bilastine were estimated from the van ’t Hoff equation using the dissociation constants. These constants were obtained from the displacement curves against the binding of [3H] mepyramine to membrane preparations of Chinese hamster ovary cells expressing wild-type human H1 receptors and their Lys179ECL2 or Lys1915.39 mutants to alanine at various temperatures. We found that the binding of bilastine to wild-type H1 receptors occurred by enthalpy-dependent binding forces and, more dominantly, entropy-dependent binding forces. The mutation of Lys179ECL2 and Lys1915.39 to alanine reduced the affinity of bilastine to H1 receptors by reducing enthalpy- and entropy-dependent binding forces, respectively. These results suggest that Lys179ECL2 and Lys1915.39 differentially contribute to the increased binding affinity to bilastine via electrostatic and hydrophobic binding forces.
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Teixeira JG, Oliveira J. Voltammetric Study of the Antihistamine Drug Bilastine: Anodic Characterization and Quantification Using a Reusable MWCNTs Modified Screen Printed Carbon Electrode. ELECTROANAL 2020. [DOI: 10.1002/elan.202060494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jorge Ginja Teixeira
- Chemistry Department of Science and Technology School Évora University CLAV Rua Romão Ramalho 59 7000-671 Évora Portugal
- HERCULES Laboratory Évora University Palácio do Vimioso Largo Marquês de Marialva 8 7000–809 Évora Portugal
| | - João Oliveira
- Chemistry Department of Science and Technology School Évora University CLAV Rua Romão Ramalho 59 7000-671 Évora Portugal
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Mizuguchi H, Wakugawa T, Sadakata H, Kamimura S, Takemoto M, Nakagawa T, Yabumoto M, Kitamura Y, Takeda N, Fukui H. Elucidation of Inverse Agonist Activity of Bilastine. Pharmaceutics 2020; 12:pharmaceutics12060525. [PMID: 32521742 PMCID: PMC7355758 DOI: 10.3390/pharmaceutics12060525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
H1-antihistamines antagonize histamine and prevent it from binding to the histamine H1 receptor (H1R). Some of them also act as inverse agonists, which are more potent than pure antagonists because they suppress the constitutive H1R activity. Bilastine is a non-sedative antihistamine which is one of the most satisfy the requirements for oral antihistamines. However, there is no information to show the inverse agonist activity of bilastine including inositol phosphates accumulation, and its inverse agonist activity is yet to be elucidated. Here we evaluated whether bilastine has inverse agonist activity or not. Intracellular calcium concentration was measured using Fluo-8. Inositol phosphates accumulation was assayed using [3H]myo-inositol. The H1R mRNA level was measured using real-time RT-PCR. At rest, Ca2+ oscillation was observed, indicating that H1R has intrinsic activity. Bilastine attenuated this fluorescence oscillation. Bilastine suppressed the increase in IPs formation in a dose-dependent manner and it was about 80% of the control level at the dose of 3 μM. Bilastine also suppressed histamine-induced increase in IPs formation to the control level. Furthermore, bilastine suppressed basal H1R gene expression in a dose-dependent manner. Data suggest that bilastine is an inverse agonist. Preseasonal prophylactic administration with bilastine could down-regulate basal H1R gene expression in the nasal mucosa and ameliorate the nasal symptoms during the peak pollen period.
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Affiliation(s)
- Hiroyuki Mizuguchi
- Laboratory of Pharmacology Faculty of Pharmacy Osaka Ohtani University, Osaka 584-8540, Japan; (M.T.); (T.N.)
- Correspondence: ; Tel.: +81-721-24-9462
| | - Tomoharu Wakugawa
- Department of Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8505, Japan;
| | | | - Seiichiro Kamimura
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8505, Japan; (S.K.); (Y.K.); (N.T.); (H.F.)
| | - Mai Takemoto
- Laboratory of Pharmacology Faculty of Pharmacy Osaka Ohtani University, Osaka 584-8540, Japan; (M.T.); (T.N.)
| | - Tomomi Nakagawa
- Laboratory of Pharmacology Faculty of Pharmacy Osaka Ohtani University, Osaka 584-8540, Japan; (M.T.); (T.N.)
| | | | - Yoshiaki Kitamura
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8505, Japan; (S.K.); (Y.K.); (N.T.); (H.F.)
| | - Noriaki Takeda
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8505, Japan; (S.K.); (Y.K.); (N.T.); (H.F.)
| | - Hiroyuki Fukui
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8505, Japan; (S.K.); (Y.K.); (N.T.); (H.F.)
- Medical Corporation Kinshukai, Osaka 558-0011, Japan;
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Abstract
Objective: Bilastine is a potent and highly selective H1-antihistamine approved for the treatment of allergic rhinoconjunctivitis and urticaria. This article summarizes available data on the use of bilastine in the treatment of allergic disorders in different age groups, including younger and older adults, and school-age children and adolescents.Methods: A PubMed literature search ("bilastine") was conducted on 25 February 2019. Additional literature known to the authors and identified from the reference lists of cited publications was included.Results: Bilastine is administered orally at a dose of 20 mg once daily in adults and adolescents aged ≥12 years and 10 mg once daily in children aged 6 to <12 years. Clinical trials have demonstrated its efficacy at improving nasal and ocular symptoms in patients with allergic rhinitis, and wheals and itching in patients with urticaria. It has a rapid onset of action and long duration of action. Bilastine does not undergo significant metabolism and does not interact with the CYP450 system, which limits its potential for drug-drug interactions. No dosage adjustments are required in patients with renal or hepatic impairment, or in the elderly. Bilastine is generally well tolerated, even when administered at above-standard doses. It does not exhibit anticholinergic effects or cardiotoxic effects, shows no central nervous system penetration and has minimal sedative properties. It has been shown to improve health-related quality of life.Conclusions: Bilastine is a suitable option for the treatment of patients with allergic rhinoconjunctivitis or urticaria across age groups from school-age children to elderly patients.
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Affiliation(s)
- Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marysia Tiongco-Recto
- Department of Paediatrics, Section of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Zoltán Novák
- Paediatric Department, University of Szeged, Szeged, Hungary
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16
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Cataldi M, Maurer M, Taglialatela M, Church MK. Cardiac safety of second‐generation H
1
‐antihistamines when updosed in chronic spontaneous urticaria. Clin Exp Allergy 2019; 49:1615-1623. [DOI: 10.1111/cea.13500] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Mauro Cataldi
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | - Maurizio Taglialatela
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Martin K. Church
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
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17
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Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci 2019; 20:ijms20010213. [PMID: 30626077 PMCID: PMC6337346 DOI: 10.3390/ijms20010213] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Antihistamines targeting the histamine H1 receptor play an important role in improving and maintaining the quality of life of patients with allergic rhinitis. For more effective and safer use of second-generation drugs, which are recommended by various guidelines, a classification based on their detailed characteristics is necessary. Antihistamines for first-line therapy should not have central depressant/sedative activities. Sedative properties (drowsiness and impaired performance) are associated with the inhibition of central histamine neurons. Brain H1 receptor occupancy (H1RO) is a useful index shown to be correlated with indices based on clinical findings. Antihistamines are classified into non-sedating (<20%), less-sedating (20–50%), and sedating (≥50%) groups based on H1RO. Among the non-sedating group, fexofenadine and bilastine are classified into “non-brain-penetrating antihistamines” based on the H1RO. These two drugs have many common chemical properties. However, bilastine has more potent binding affinity to the H1 receptor, and its action tends to last longer. In well-controlled studies using objective indices, bilastine does not affect psychomotor or driving performance even at twice the usual dose (20 mg). Upon selecting antihistamines for allergic rhinitis, various situations should be taken into our consideration. This review summarizes that the non-brain-penetrating antihistamines should be chosen for the first-line therapy of mild allergic rhinitis.
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Anti-allergic rhinitis effects of caffeoylquinic acids from the fruits of Xanthium strumarium in rodent animals via alleviating allergic and inflammatory reactions. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2019. [DOI: 10.1016/j.bjp.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Bosma R, van den Bor J, Vischer HF, Labeaga L, Leurs R. The long duration of action of the second generation antihistamine bilastine coincides with its long residence time at the histamine H 1 receptor. Eur J Pharmacol 2018; 838:107-111. [PMID: 30201377 DOI: 10.1016/j.ejphar.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022]
Abstract
Drug-target binding kinetics has recently attracted considerable interest in view of the potential predictive power for in vivo drug efficacy. The recently introduced antihistamine bilastine has a long duration of in vivo drug action, which outlasts pharmacological active bilastine concentrations in blood. To provide a molecular basis for the long duration of action, we explored the kinetics of bilastine binding to the human histamine H1 receptor using [3H]mepyramine binding studies and compared its pharmacodynamics properties to the reference compounds fexofenadine and diphenhydramine, which have a long (60 ± 20 min) and short (0.41 ± 0.1 min) residence time, respectively. Bilastine shows a long drug-target residence time at the H1 receptor (73 ± 5 min) and this results in a prolonged H1 receptor antagonism in vitro (Ca2+ mobilization in Fluo-4 loaded HeLa cells), following a washout of unbound antagonist. Hence, the long residence time of bilastine can explain the observed long duration of drug action in vivo.
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Affiliation(s)
- Reggie Bosma
- Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Jelle van den Bor
- Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Henry F Vischer
- Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Luis Labeaga
- Clinical Research Department, Faes Farma SA, Leioa, Bizkaia, Spain
| | - Rob Leurs
- Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands.
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20
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Irwin JJ, Gaskins G, Sterling T, Mysinger MM, Keiser MJ. Predicted Biological Activity of Purchasable Chemical Space. J Chem Inf Model 2017; 58:148-164. [PMID: 29193970 PMCID: PMC5780839 DOI: 10.1021/acs.jcim.7b00316] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
![]()
Whereas
400 million distinct compounds are now purchasable within
the span of a few weeks, the biological activities of most are unknown.
To facilitate access to new chemistry for biology, we have combined
the Similarity Ensemble Approach (SEA) with the maximum Tanimoto similarity
to the nearest bioactive to predict activity for every commercially
available molecule in ZINC. This method, which we label SEA+TC, outperforms
both SEA and a naïve-Bayesian classifier via predictive performance
on a 5-fold cross-validation of ChEMBL’s bioactivity data set
(version 21). Using this method, predictions for over 40% of compounds
(>160 million) have either high significance (pSEA ≥ 40),
high
similarity (ECFP4MaxTc ≥ 0.4), or both, for one or more of
1382 targets well described by ligands in the literature. Using a
further 1347 less-well-described targets, we predict activities for
an additional 11 million compounds. To gauge whether these predictions
are sensible, we investigate 75 predictions for 50 drugs lacking a
binding affinity annotation in ChEMBL. The 535 million predictions
for over 171 million compounds at 2629 targets are linked to purchasing
information and evidence to support each prediction and are freely
available via https://zinc15.docking.org and https://files.docking.org.
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Affiliation(s)
- John J Irwin
- Department of Pharmaceutical Chemistry, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158-2330, United States
| | - Garrett Gaskins
- Department of Pharmaceutical Chemistry, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158-2330, United States.,Institute for Neurodegenerative Diseases, University of California, San Francisco , 675 Nelson Rising Lane, San Francisco, California 94158, United States.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158, United States.,Institute for Computational Health Sciences, University of California, San Francisco , 550 16th Street, San Francisco, California 94158, United States
| | - Teague Sterling
- Department of Pharmaceutical Chemistry, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158-2330, United States
| | - Michael M Mysinger
- Department of Pharmaceutical Chemistry, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158-2330, United States
| | - Michael J Keiser
- Department of Pharmaceutical Chemistry, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158-2330, United States.,Institute for Neurodegenerative Diseases, University of California, San Francisco , 675 Nelson Rising Lane, San Francisco, California 94158, United States.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco , Byers Hall, 1700 4th Street, San Francisco, California 94158, United States.,Institute for Computational Health Sciences, University of California, San Francisco , 550 16th Street, San Francisco, California 94158, United States
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21
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Church MK, Labeaga L. Bilastine: a new H 1 -antihistamine with an optimal profile for updosing in urticaria. J Eur Acad Dermatol Venereol 2017; 31:1447-1452. [PMID: 28467671 DOI: 10.1111/jdv.14305] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/05/2017] [Indexed: 12/18/2022]
Abstract
This review set out to examine published papers detailing the efficacy of bilastine in skin models and urticaria to assess whether it meets the optimal profile for updosing in urticaria, that is, strong clinical efficacy and freedom from unwanted side effects, particularly sedation. Bilastine is a highly effective H1 -antihistamine even when used at the basic dose of 20 mg daily. Its facilitated uptake after oral dosage gives it a rapid onset and long duration of action. In both wheal and flare studies and in urticaria updosing fourfold showed increased effectiveness. With respect to somnolence, bilastine is a substrate for P-glycoprotein, a membrane pump which prevents it crossing the blood-brain barrier. Consequently, bilastine is a practically 'non-sedating' H1 -antihistamine. In conclusion, the excellent profile of bilastine in both efficacy and safety make it the ideal H1 -antihistamine for updosing the daily dose fourfold in difficult-to-treat urticaria as recommended by the EAACI/GA2 LEN/EDF/WAO guideline for the management of urticaria.
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Affiliation(s)
- M K Church
- Department of Dermatology and Allergy, Allergy Centre Charité, Charité Universitätsmedizin, Berlin, Germany
| | - L Labeaga
- Medical Department, FAES Farma, S.A., Bilbao, Spain
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22
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Kumar A, Ahmed QN. A Benzoquinone Imine Assisted Ring-Opening/Ring-Closing Strategy of the RCOCHN1
N2
System: Dinitrogen Extrusion Reaction to Benzimidazoles. European J Org Chem 2017. [DOI: 10.1002/ejoc.201700357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Atul Kumar
- Medicinal Chemistry Division; Indian Institute of Integrative Medicine (IIIM); Canal Road 180001 Jammu Jammu & Kashmir India
- Academy of Scientific and Innovative Research (AcSIR); Indian Institute of Integrative Medicine (IIIM); Canal Road 180001 Jammu Jammu & Kashmir India
| | - Qazi Naveed Ahmed
- Medicinal Chemistry Division; Indian Institute of Integrative Medicine (IIIM); Canal Road 180001 Jammu Jammu & Kashmir India
- Academy of Scientific and Innovative Research (AcSIR); Indian Institute of Integrative Medicine (IIIM); Canal Road 180001 Jammu Jammu & Kashmir India
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Hide M, Yagami A, Togawa M, Saito A, Furue M. Efficacy and safety of bilastine in Japanese patients with chronic spontaneous urticaria: A multicenter, randomized, double-blind, placebo-controlled, parallel-group phase II/III study. Allergol Int 2017; 66:317-325. [PMID: 27599913 DOI: 10.1016/j.alit.2016.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/24/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Bilastine, a novel non-sedating second-generation H1-antihistamine, has been widely used in the treatment of allergic rhinoconjunctivitis and urticaria with a recommended dose of 20 mg once daily in most European countries since 2010. We evaluated its efficacy and safety in Japanese patients with chronic spontaneous urticaria (CSU). METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled phase II/III study (trial registration No. JapicCTI-142574). Patients (age, 18-74 years) were randomly assigned to receive bilastine 20 mg, 10 mg or placebo once daily for 2 weeks. The primary efficacy endpoint was the change from baseline (Day -3 to 0) in total symptom score (TSS) at 2 weeks (Day 8-14), consisting of the itch and rash scores. RESULTS A total of 304 patients were randomly allocated to bilastine 20 mg (101 patients), bilastine 10 mg (100 patients), and placebo (103 patients). The changes in TSS at 2 weeks were significantly decreased by bilastine 20 mg than did placebo (p < 0.001), demonstrating the superiority of bilastine 20 mg. Bilastine 10 mg also showed a significant difference from placebo (p < 0.001). The TSS changes for the bilastine showed significant improvement from Day 1, and were maintained during the treatment period. The Dermatology Life Quality Index scores were also improved in bilastine than in placebo. The bilastine treatments were safe and well tolerated. CONCLUSIONS Two-week treatment with bilastine (20 or 10 mg) once daily was effective and tolerable in Japanese patients with CSU, demonstrating an early onset of action.
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Leceta A, Sologuren A, Valiente R, Campo C, Labeaga L. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department. Drugs Context 2017; 6:212500. [PMID: 28210286 PMCID: PMC5299972 DOI: 10.7573/dic.212500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs). Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. DATA SOURCES AND METHODS Queries received by the Medical Information Department and the responses provided to senders of these queries. RESULTS The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants), antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in the Summary of Product Characteristics (SmPC), which suggests that this resource is not being well used. CONCLUSIONS Overall, this analysis highlights gaps in our knowledge regarding the optimal use of bilastine. Expert opinion based upon an understanding of the science can help in the decision-making, but more research is needed to provide evidence-based answers in certain circumstances.
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Affiliation(s)
- Amalia Leceta
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Ander Sologuren
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Román Valiente
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Cristina Campo
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Luis Labeaga
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
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Okubo K, Gotoh M, Asako M, Nomura Y, Togawa M, Saito A, Honda T, Ohashi Y. Efficacy and safety of bilastine in Japanese patients with perennial allergic rhinitis: A multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III study. Allergol Int 2017; 66:97-105. [PMID: 27421817 DOI: 10.1016/j.alit.2016.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bilastine, a novel non-sedating second-generation H1 antihistamine, has been approved in most European countries since 2010. This study aimed to evaluate the superiority of bilastine over placebo in Japanese patients with perennial allergic rhinitis (PAR). METHODS This randomized, double-blind, placebo-controlled, parallel-group, phase III study (trial registration number JapicCTI-142600) evaluated the effect of a 2-week treatment period with bilastine (20 mg once daily), fexofenadine (60 mg twice daily), or a matched placebo (double dummy) in patients with PAR. All patients were instructed to record individual nasal and ocular symptoms in diaries daily. The primary endpoint was the mean change in total nasal symptom scores (TNSS) from baseline to Week 2 (Days 10-13). RESULTS A total of 765 patients were randomly allocated to receive bilastine, fexofenadine, or placebo (256, 254, and 255 patients, respectively). The mean change in TNSS from baseline at Week 2 was significantly decreased by bilastine (-0.98) compared to placebo (-0.63, P = 0.023). Bilastine and fexofenadine showed no significant difference in the primary endpoint. However, the mean change in TNSS from baseline on Day 1 was more significantly decreased by bilastine (-0.99) than by placebo (-0.28, P < 0.001) or fexofenadine (-0.62, P = 0.032). The active drugs also improved instantaneous TNSS 1 h after the first and before the second drug administration on Day 1 (P < 0.05). The study drugs were well tolerated. CONCLUSIONS After 2-week treatment period, bilastine 20 mg once daily was effective and tolerable in Japanese patients with PAR, and exhibited a rapid onset of action.
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Affiliation(s)
- Kimihiro Okubo
- Department of Otolaryngology-Head and Neck Surgery, Nippon Medical School, Tokyo, Japan.
| | - Minoru Gotoh
- Department of Otolaryngology, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Mikiya Asako
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Osaka, Japan
| | - Yasuyuki Nomura
- Department of Otolaryngology-Head and Neck Surgery, Nihon University, Tokyo, Japan
| | - Michinori Togawa
- Clinical Development Division, Taiho Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Akihiro Saito
- Clinical Development Division, Taiho Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Takayuki Honda
- Clinical Development Division, Taiho Pharmaceutical Co., Ltd., Tokyo, Japan
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The role and choice criteria of antihistamines in allergy management - expert opinion. Postepy Dermatol Alergol 2016; 33:397-410. [PMID: 28035215 PMCID: PMC5183790 DOI: 10.5114/pdia.2016.63942] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/18/2016] [Indexed: 12/20/2022] Open
Abstract
Allergic diseases are the most common chronic conditions lasting throughout the patient’s life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society. Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and paediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases. What is the truth? What are the data from clinical trials and observational studies? Are all drugs equally effective and safe for the patient? According to a panel of experts representing various fields of medicine, inappropriate treatment of allergies can be very risky for patients, and seemingly equally acting medications may differ greatly. Therefore, a panel of experts gathered the latest data from the entire scientific literature and analysed the latest standards and recommendations prepared by scientific societies. This paper provides a summary of these studies and highlights the importance for the patient of the proper choice of drug to treat his allergies.
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Novák Z, Yáñez A, Kiss I, Kuna P, Tortajada-Girbés M, Valiente R. Safety and tolerability of bilastine 10 mg administered for 12 weeks in children with allergic diseases. Pediatr Allergy Immunol 2016; 27:493-8. [PMID: 26918853 DOI: 10.1111/pai.12555] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Regulations on medicinal products for paediatric use require that pharmacokinetics and safety be characterized specifically in the paediatric population. A previous study established that a 10-mg dose of bilastine in children aged 2 to <12 years provided an equivalent systemic exposure as 20 mg in adults. The current study assessed the safety and tolerability of bilastine 10 mg in children with allergic rhinoconjunctivitis and chronic urticaria. METHODS In this phase III, multicentre, double-blind study, children were randomized to once-daily treatment with bilastine 10-mg oral dispersible table (n = 260) or placebo (n = 249) for 12 weeks. Safety evaluations included treatment-emergent adverse events (TEAEs), laboratory tests, cardiac safety (ECG recordings) and somnolence/sedation using the Pediatric Sleep Questionnaire (PSQ). RESULTS The primary hypothesis of non-inferiority between bilastine 10 mg and placebo was demonstrated on the basis of a near-equivalent proportion of children in each treatment arm without TEAEs during 12 weeks' treatment (31.5 vs. 32.5%). No clinically relevant differences between bilastine 10 mg and placebo were observed from baseline to study end for TEAEs or related TEAEs, ECG parameters and PSQ scores. The majority of TEAEs were mild or moderate in intensity. TEAEs led to discontinuation of two patients treated with bilastine 10 mg and one patient treated with placebo. CONCLUSIONS Bilastine 10 mg had a safety and tolerability profile similar to that of placebo in children aged 2 to <12 years with allergic rhinoconjunctivitis or chronic urticaria.
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Affiliation(s)
- Zoltán Novák
- Aranyklinika Egészségügyi és Innovációs Kft., Szeged, Hungary
| | - Anahí Yáñez
- INAER-Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Ildikó Kiss
- Children Department, Zala Megyei Kórház, Zalaegerszeg, Hungary
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Román Valiente
- Clinical Research Department, FAES FARMA S. A., Leioa, Bizkaia, Spain
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Wang XY, Lim-Jurado M, Prepageran N, Tantilipikorn P, Wang DY. Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine. Ther Clin Risk Manag 2016; 12:585-97. [PMID: 27110120 PMCID: PMC4835134 DOI: 10.2147/tcrm.s105189] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Allergic rhinitis and urticaria are common allergic diseases that may have a major negative impact on patients' quality of life. Bilastine, a novel new-generation antihistamine that is highly selective for the H1 histamine receptor, has a rapid onset and prolonged duration of action. This agent does not interact with the cytochrome P450 system and does not undergo significant metabolism in humans, suggesting that it has very low potential for drug-drug interactions, and does not require dose adjustment in renal impairment. As bilastine is not metabolized and is excreted largely unchanged, hepatic impairment is not expected to increase systemic exposure above the drug's safety margin. Bilastine has demonstrated similar efficacy to cetirizine and desloratadine in patients with seasonal allergic rhinitis and, in a Vienna Chamber study, a potentially longer duration of action than fexofenadine in patients with asymptomatic seasonal allergic rhinitis. It has also shown significant efficacy (similar to that of cetirizine) and safety in the long-term treatment of perennial allergic rhinitis. Bilastine showed similar efficacy to levocetirizine in patients with chronic spontaneous urticaria and can be safely used at doses of up to fourfold higher than standard dosage (80 mg once daily). The fourfold higher than standard dose is specified as an acceptable second-line treatment option for urticaria in international guidelines. Bilastine is generally well tolerated, both at standard and at supratherapeutic doses, appears to have less sedative potential than other second-generation antihistamines, and has no cardiotoxicity. Based on its pharmacokinetic properties, efficacy, and tolerability profile, bilastine will be valuable in the management of allergic rhinitis and urticaria.
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Affiliation(s)
- Xue Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | - Narayanan Prepageran
- Department of Otorhinolaryngology, Head & Neck Surgery, University Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Pongsakorn Tantilipikorn
- Rhinology and Allergy Division, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Development of drugs based on imidazole and benzimidazole bioactive heterocycles: recent advances and future directions. Med Chem Res 2015. [DOI: 10.1007/s00044-015-1495-5] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Jáuregui I, Ramaekers JG, Yanai K, Farré M, Redondo E, Valiente R, Labeaga L. Bilastine: a new antihistamine with an optimal benefit-to-risk ratio for safety during driving. Expert Opin Drug Saf 2015; 15:89-98. [PMID: 26571227 DOI: 10.1517/14740338.2016.1112786] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Rational selection of a second-generation H1-antihistamine requires efficacy and safety considerations, particularly regarding central nervous system (CNS) effects (cognitive and psychomotor function), potential for driving impairment, minimal sedative effects and a lack of interactions. This review evaluates the key safety features of the non-sedating antihistamine, bilastine, during driving and in preventing road traffic accidents. AREAS COVERED Among the second-generation H1-antihistamines, sedative effects which can affect cognitive and psychomotor performance, and possibly driving ability, may not be similar. Bilastine is absorbed rapidly, undergoes no hepatic metabolism or cytochrome P450 interaction (minimal drug-drug interaction potential), and is a substrate for P-glycoprotein (limiting CNS entry). Positron emission tomography showed that, compared with other second-generation H1-antihistamines, bilastine has the lowest cerebral histamine H1-receptor occupancy. Bilastine 20 mg once daily (therapeutic dose) is non-sedating, does not enhance the effects of alcohol or CNS sedatives, does not impair driving performance and has at least similar efficacy as other second-generation H1-antihistamines in the treatment of allergic rhinoconjunctivitis and urticaria. EXPERT OPINION Current evidence shows that bilastine has an optimal benefit-to-risk ratio, meeting all conditions for contributing to safety in drivers who need antihistamines, and hence for being considered as an antihistamine of choice for drivers.
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Affiliation(s)
- Ignacio Jáuregui
- a Allergy Department , Basurto University Hospital , Bilbao 48013 , Spain
| | - Johannes G Ramaekers
- b Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Kazuhiko Yanai
- c Department of Pharmacology , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - Magí Farré
- d Clinical Pharmacology Unit , Hospital Universitari Germans Trias i Pujol-IGTP, Hospital del Mar Medical Research Institute-IMIM, and Universidad Autónoma de Barcelona-UAB , Barcelona , Spain
| | - Esther Redondo
- e Coordinadora del Grupo de Trabajo de Actividades Preventivas de SEMERGEN , International Health Center , Madrid , Spain
| | - Román Valiente
- f Medical and Clinical Department , FAES FARMA S. A. , Leioa , Spain
| | - Luis Labeaga
- f Medical and Clinical Department , FAES FARMA S. A. , Leioa , Spain
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Farré M, Pérez-Mañá C, Papaseit E, Menoyo E, Pérez M, Martin S, Bullich S, Rojas S, Herance JR, Trampal C, Labeaga L, Valiente R. Bilastine vs. hydroxyzine: occupation of brain histamine H1 -receptors evaluated by positron emission tomography in healthy volunteers. Br J Clin Pharmacol 2015; 78:970-80. [PMID: 24833043 PMCID: PMC4243871 DOI: 10.1111/bcp.12421] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/08/2014] [Indexed: 12/16/2022] Open
Abstract
AIM A close correlation exists between positron emission tomography (PET)-determined histamine H1 -receptor occupancy (H1 RO) and the incidence of sedation. Antihistamines with H1 RO <20% are classified as non-sedating. The objective was to compare the H1 RO of bilastine, a second generation antihistamine, with that of hydroxyzine. METHODS This randomized, double-blind, crossover study used PET imaging with [(11) C]-doxepin to evaluate H1 RO in 12 healthy males (mean age 26.2 years), after single oral administration of bilastine (20 mg), hydroxyzine (25 mg) or placebo. Binding potentials and H1 ROs were calculated in five cerebral cortex regions of interest: frontal, occipital, parietal, temporal, insula. Plasma bilastine concentrations, subjective sedation (visual analogue scale), objective psychomotor performance (digital symbol substitution test), physiological variables and safety (adverse events, AEs), were also evaluated. RESULTS The mean binding potential of all five regions of interest (total binding potential) was significantly greater with bilastine than hydroxyzine (mean value 0.26 vs. 0.13, P < 0.01; mean difference and 95% CI -0.130 [-0.155, 0.105]). There was no significant difference between bilastine and placebo. Overall H1 RO by bilastine was significantly lower than that by hydroxyzine (mean value -3.92% vs. 53.95%, P < 0.01; mean difference and 95% CI 57.870% [42.664%, 73.075%]). There was no significant linear relationship between individual bilastine plasma concentrations and total binding potential values. No significant between-treatment differences were observed for sedation and psychomotor performance. Twenty-six non-serious AEs were reported. Sleepiness or sedation was not reported with bilastine but appeared in some subjects with hydroxyzine. CONCLUSIONS A single oral dose of bilastine 20 mg had minimal H1 RO, was not associated with subjective sedation or objective impairment of psychomotor performance and was devoid of treatment-related sedative AEs, thus satisfying relevant subjective, objective and PET criteria as a non-sedating antihistamine.
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Affiliation(s)
- Magí Farré
- Human Pharmacology and Neuroscience Research Unit, Hospital del Mar Medical Research Institute-IMIM, and Universidad Autónoma de Barcelona-UAB, Barcelona, Spain
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Abstract
BACKGROUND Allergic rhinitis is a very frequent disease. H1 antihistamines have been used for treatment of allergic rhinitis for more than 5 decades. They differ in chemical structure, pharmacokinetics, pharmacodynamics, clinical efficacy and adverse effects. METHODS We performed a detailed analysis of all available publications concerning the new H1-antihistamine bilasitine. RESULTS Bilastine, a piperidine derivative, is a novel potent H1 antihistamine. It is at least as potent as cetirizine or fexofenadine in in vitro studies. In animal studies it demonstrates dose-dependent antihistaminic and antiallergic effects. In humans its metabolism is not affected by age, gender or renal function but may be affected by coadministration of P glycoprotein inhibitors. Efficacy of bilastine in therapy of allergic rhinitis patients has been documented in several large controlled clinical trials showing bilastine being at least as effective as cetirizine or desloratadine. No significant suppressive effect on central nervous system could be demonstrated when bilastine was used in the recommended doses. CONCLUSION Bilastine is a novel H1 antihistamine with anti-allergic properties which is highly effective in the treatment of symptoms of allergic rhinitis. It has a favorable pharmacokinetic and pharmacodynamic profile and is generally well tolerated.
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Affiliation(s)
- Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
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Ridolo E, Montagni M, Bonzano L, Incorvaia C, Canonica GW. Bilastine: new insight into antihistamine treatment. Clin Mol Allergy 2015; 13:1. [PMID: 25878559 PMCID: PMC4397738 DOI: 10.1186/s12948-015-0008-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
Bilastine is a new second generation H1-antihistamine recently approved for the symptomatic treatment of allergic rhinitis (AR) and chronic urticaria (CU). Bilastine epitomizes the evolution of research on antihistamines concerning both efficacy and safety. In AR treatment, a number of large controlled clinical trials documented its efficacy, as assessed by improvement of all nasal and ocular symptoms and quality of life. These outcomes show that bilastine meets current EAACI/ARIA criteria for medications used in the treatment of AR. Also in CU, the review of the literature indicates that once-daily treatment with bilastine 20 mg was effective in managing symptoms and improving patient's quality of life. Concerning safety and tolerability, the profile of bilastine is very similar to placebo and in particular the adverse effects on central nervous system are insignificant. The balance of efficacy and safety of bilastine is particularly helpful when dosages higher than standard are needed to control the symptoms, as frequently occurs in patients with urticaria, in whom antihistamines doses up to four times the standard dose may be administered.
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Affiliation(s)
- Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, Parma, 43126 Italy
| | - Marcello Montagni
- Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, Parma, 43126 Italy
| | - Laura Bonzano
- Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, Parma, 43126 Italy
| | | | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Li Q, Hu Q, Wang X, Zong Y, Zhao L, Xing J, Zhou J, Zhang H. Discovery of Novel 2-(piperidin-4-yl)-1H-benzo[d]imidazole Derivatives as Potential Anti-Inflammatory Agents. Chem Biol Drug Des 2015; 86:509-16. [DOI: 10.1111/cbdd.12513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Qing Li
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
| | - Qinghua Hu
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing 210009 China
| | - Xinning Wang
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
| | - Yang Zong
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
| | - Leilei Zhao
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
| | - Junhao Xing
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
| | - Jinpei Zhou
- Department of Medicinal Chemistry; China Pharmaceutical University; 24 Tongjia Xiang Nanjing 210009 China
| | - Huibin Zhang
- Center of Drug Discovery; China Pharmaceutical University; Nanjing 210009 China
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing 210009 China
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Jie Q, Kodithuwakku ND, Yuan X, He G, Chen M, Xu S, Wu Y. Anti-allergic and anti-inflammatory properties of a potent histamine H1 receptor antagonist, desloratadine citrate disodium injection, and its anti-inflammatory mechanism on EA.hy926 endothelial cells. Eur J Pharmacol 2015; 754:1-10. [PMID: 25704613 DOI: 10.1016/j.ejphar.2015.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
The present study, demonstrates that, desloratadine citrate disodium injection (DLC) possesses antihistaminic, anti-allergic and anti-inflammatory properties and elucidates its molecular mechanisms of anti-inflammatory properties. In vitro antihistamine activity of DLC was determined in guinea pig isolated tissues. In vivo antihistamine effects were evaluated after following intravenous administration of DLC in mice with histamine- induced paw edema and in rats with increased capillary permeability. Anti-allergic effects were assessed through passive cutaneous anaphylactic (PCA) reactions in sensitized rodents and ovalbumin-induced allergic rhinitis in rats. Anti-inflammatory properties and molecular mechanisms of DLC were determined on histamine- and lipopolysaccharide (LPS)-induced EA.hy926 endothelial cells. DLC exhibited significant and reversible inhibition of histamine-induced contractions of isolated guinea pig ileum with pA2 value of 8.88. Histamine-induced paw edema and increased capillary permeability were notably inhibited by DLC intravenous administration. In the model of PCA reactions, DLC showed significant activity in a dose-dependent nd potently inhibited both the early-phase and late-phase allergic reaction of ovalbumin-induced allergic rhinitis in rats. DLC alleviated the rhinitis symptoms and inhibited inflammatory cell infiltration, IL-4 and protein leakage in nasal lavage fluid (NLF). In EA.hy926 cells, DLC significantly inhibited the histamine- and LPS- induced IL-6 and IL-8 production and P-selectin and intercellular cell adhesion molecule-1 (ICAM-1) expression. Moreover, DLC reduced translocation of nuclear factor-kappaB (NF-κB) to the nucleus in activated EA.hy926 cells. These results provide evidence that DLC possesses potent antihistaminic, anti-allergic and, anti-inflammatory properties via suppressing IL-6, IL-8, P-selectin and ICAM-1 expression.
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Affiliation(s)
- Qiong Jie
- Department of Physiology, China Pharmaceutical University, Nanjing 210009, Jiangsu, China
| | | | - Xin Yuan
- Department of Physiology, China Pharmaceutical University, Nanjing 210009, Jiangsu, China
| | - Guangwei He
- Hefei Yigong Medicine Co., Ltd, Hefei 230088, Anhui, China
| | - Meiling Chen
- Department of Physiology, China Pharmaceutical University, Nanjing 210009, Jiangsu, China
| | - Shuhong Xu
- Department of Physiology, China Pharmaceutical University, Nanjing 210009, Jiangsu, China
| | - Yulin Wu
- Department of Physiology, China Pharmaceutical University, Nanjing 210009, Jiangsu, China.
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Sánchez-Borges M, Ansotegui I, Jimenez JM, Rojo MI, Serrano C, Yañez A. Comparative efficacy of non-sedating antihistamine updosing in patients with chronic urticaria. World Allergy Organ J 2014; 7:33. [PMID: 25829981 PMCID: PMC4363057 DOI: 10.1186/1939-4551-7-33] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | | | | | - Carlos Serrano
- Allergy Unit, Hospital Fundación Valle del Lili, Cali, Colombia
| | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias, InAER, Buenos Aires, Argentina
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Abstract
PURPOSE OF REVIEW Allergic rhinitis due its high prevalence and burden needs to be properly treated. The disease's clinical features impose well tolerated drugs usable for long-term treatment. Nowadays, second-generation antihistamines and inhaled steroids represent the milestone of rhinitis therapy. The aim of the present review is to provide an update on allergic rhinitis treatment. A particular attention has been deserved to clinical trials, published in the last year that assess the efficacy and safety of new formulation of available drugs or new molecules. RECENT FINDINGS Available and new drugs under investigation seem able to control rhinitis symptoms without a significant patient's burden. The challenge for the next years will be to improve treatment adherence rather than to introduce new drugs. SUMMARY Allergic Rhinitis and its Impact on Asthma guidelines have brought attention to allergic rhinitis and its impact on asthma, but have also proposed a new classification in terms of symptoms severity and persistence useful for tailoring treatment on patients' phenotypes. Their further dissemination is needed; furthermore, they represent a cornerstone for the scientific community through a continuous update on relevant issues such as rhinitis phenotypes, disease management on the basis of new treatments, clinical trials transferability in real life, and allergic rhinitis management in public health programs.
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Cardiovascular safety of antihistamines. Postepy Dermatol Alergol 2014; 31:182-6. [PMID: 25097491 PMCID: PMC4112269 DOI: 10.5114/pdia.2014.43191] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/22/2014] [Accepted: 03/25/2014] [Indexed: 01/30/2023] Open
Abstract
Histamine is a mediator, which increases the permeability of capillaries during the early phase of allergic reaction, causes smooth muscle contraction of bronchi and stimulates mucous glands in the nasal cavity. Antihistamines are the basis of symptomatic treatment in the majority of allergic diseases, especially allergic rhinitis, allergic conjunctivitis, urticaria and anaphylaxis. The cardiotoxic effects of the two withdrawn drugs, terfenadine and astemizole, were manifested by prolonged QT intervals and triggering torsades de pointes (TdP) caused by blockade of the ‘rapid’ IKr potassium channels. These phenomena, however, are not a class effect. This review deals with a new generation of antihistamine drugs in the context of QT interval prolongation risk.
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Abstract
Because of its burden on patient's lives and its impact on asthma, allergic rhinitis must be treated properly with more effective and safer treatments. According to guidelines by Allergic Rhinitis and Its Impact on Asthma (ARIA), the classification, pathogenesis, and treatment of allergic rhinitis are well defined. Currently, second-generation antihistamines and inhaled steroids are considered the cornerstone of first-line therapy. However, new formulations of available drugs (e.g., loratadine and rupatadine oral solution, ebastine fast-dissolving tablets, and the combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (e.g., ciclesonide, bilastine, and phosphodiesterase-4 inhibitors), immunologic targets (e.g., omalizumab), and unconventional treatments (e.g., homeopathic treatments) are currently under investigation and represent a new frontier in modern medicine and in allergic rhinitis management. The aim of this review is to provide an update on allergic rhinitis treatment, paying particular attention to clinical trials published within the past 20 months that assessed the efficacy and safety of new formulations of available drugs or new molecules.
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Lasseter KC, Sologuren A, La Noce A, Dilzer SC. Evaluation of the single-dose pharmacokinetics of bilastine in subjects with various degrees of renal insufficiency. Clin Drug Investig 2014; 33:665-73. [PMID: 23873362 PMCID: PMC3751212 DOI: 10.1007/s40261-013-0110-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bilastine is a novel second-generation H1 antihistamine, which has not shown sedative or cardiotoxic effects in clinical trials and in post-marketing experience so far, developed for the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. It has recently been granted marketing authorization for these therapeutic indications in adults and adolescents at a once-daily oral dose of 20 mg in several European countries. OBJECTIVE This study was conducted to determine the pharmacokinetics of bilastine at a single oral dose of 20 mg in renally impaired subjects. The need for a dose adjustment in patients with renal insufficiency was assessed by comparing the exposure to bilastine in these subjects with the estimated exposure of a dose corresponding to the safety margin. METHODS The study was an open-label, single-dose, parallel-group study of the pharmacokinetics and safety of a single dose of bilastine. The study was conducted as an in-patient setting at a clinical pharmacology facility. A total of 24 male or female subjects aged 18-80 years were to be enrolled in four groups of six subjects each. The groups were as follows: (1) healthy [glomerular filtration rate (GFR) >80 mL/min/1.73 m(2)]; (2) mild renal insufficiency (GFR 50-80 mL/min/1.73 m(2)); (3) moderate renal insufficiency (GFR 30-50 mL/min/1.73 m(2)); and (4) severe renal insufficiency (GFR ≤30 mL/min/1.73 m(2)). A single 20 mg bilastine tablet was administered in a fasted state. Blood and urine samples were collected from pre-dose up to 72 h post-dose for bilastine pharmacokinetic analysis. Pharmacokinetic results were summarized using appropriate descriptive statistics. RESULTS There was a clear trend of increasing area under the plasma concentration-time curve (AUC) and maximum plasma concentration (C(max)) through the groups 1-4. The mean AUC from time zero to infinity (AUC(∞)) ranged from 737.4 to 1708.5 ng·h/mL in healthy subjects and severely impaired subjects, respectively. No significant differences among groups in median time to reach Cmax (tmax) or in the mean terminal disposition rate constants for bilastine were found. Renal and plasma clearance paralleled GFR. In all groups of renally impaired subjects the corresponding 90 % confidence interval of both AUC(∞) and AUC from time zero to time of last measurable plasma concentration (AUC(last)) were not within the 0.8-1.25 interval, indicating that bioequivalence between groups could not be demonstrated. The majority of bilastine was excreted within the first 12 h, and elimination was essentially complete by 72 h. CONCLUSION An oral dose of bilastine (20 mg) was well-tolerated in renal insufficiency, despite the increase in exposure. The oral plasma clearance to renal clearance ratio [(CL(P)/F)/CL(R)] was approximately equal in the different groups, suggesting that renal excretion was the main elimination route for bilastine, and no alternative elimination routes were used even in severe renal insufficiency. Although exposure to bilastine was higher in renally impaired subjects, it remained well within the safety margins, thus allowing the conclusion that a 20-mg daily dose can be safely administered to subjects with different degrees of renal insufficiency without the need for dose adjustments.
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Antihistamines (H1 receptor antagonists). ACTA ACUST UNITED AC 2014. [DOI: 10.1016/b978-0-444-62635-6.00015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Bilastine: a new nonsedating oral H1 antihistamine for treatment of allergic rhinoconjunctivitis and urticaria. BIOMED RESEARCH INTERNATIONAL 2013; 2013:626837. [PMID: 23956994 PMCID: PMC3728546 DOI: 10.1155/2013/626837] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/26/2013] [Indexed: 01/01/2023]
Abstract
Bilastine is a new, well-tolerated, nonsedating H1 receptor antihistamine. In the fasting state bilastine is quickly absorbed, but the absorption is slowed when it is taken with food or fruit juice. Therefore, it is recommended that bilastine is taken at least one hour before and no sooner than two hours after a meal. Clinical studies sponsored by the manufacturer have shown that bilastine 20 mg once daily is as efficacious as other nonsedating antihistamines in allergic rhinoconjunctivitis and chronic urticaria in individuals from 12 and 18 years of age, respectively. Bilastine is efficacious in all nasal symptoms including obstruction and in eye symptoms. The observations indicate that non-sedating antihistamines, as opposed to what has been thought previously, may be helpful in patients with allergic rhinitis in whom nasal obstruction is a major concern. Current international guidelines need to be revised in the light of the recent evidence. Research into aspects of pharmacokinetics and efficacy and adverse effect profiles of bilastine in children under 12 years of age is needed as are dose-response assessments and studies planned rigorously with the aim of assessing quality of life effects.
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Krause K, Spohr A, Zuberbier T, Church MK, Maurer M. Up-dosing with bilastine results in improved effectiveness in cold contact urticaria. Allergy 2013; 68:921-8. [PMID: 23742030 PMCID: PMC3759706 DOI: 10.1111/all.12171] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 01/07/2023]
Abstract
Background Cold contact urticaria (CCU) is characterized by itchy wheal and flare responses due to the release of histamine and other pro-inflammatory mediators after exposure to cold. The treatment of choice is nonsedating antihistamines, dosages of which may be increased up to fourfold if standard doses are ineffective. Here, we assess the effects of a standard 20 mg dose and up-dosing to 40 and 80 mg of bilastine in reducing the symptoms of CCU and inflammatory mediator release following cold challenge. Methods Twenty patients with CCU were included in this randomized, crossover, double-blind, placebo-controlled 12-week study. They received placebo, 20, 40 or 80 mg of bilastine daily each for 7 days with 14-day washout periods. The primary readout was change in critical temperature thresholds (CTT). Secondary readouts were changes in pruritus, levels of histamine IL-6, IL-8 and TNF-α collected by skin microdialysis and safety and tolerability of bilastine. Results Bilastine 20 mg was highly effective (P < 0.0001) in reducing CTT. Up-dosing to 80 mg significantly (P < 0.04) increased its effectiveness. At this dose, 19 of 20 (95%) patients responded to treatment, with 12 of 20 (60%) becoming symptom free. Only one patient was refractory to treatment. Microdialysis levels of histamine, IL-6 and IL-8 assessed 1–3 h after cold challenge were significantly (P < 0.05) decreased following up-dosing with 80 mg bilastine. Bilastine treat-ment was well tolerated without evidence of increased sedation with dose escala-tion. Conclusions Bilastine was effective in reducing the symptoms of patients with CCU. Increased efficacy of bilastine with fourfold up-dosing was without sedation and supports urticaria treatment guidelines.
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Affiliation(s)
- K. Krause
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Spohr
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. K. Church
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
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Jáuregui I, Ferrer M, Bartra J, del Cuvillo A, Dávila I, Montoro J, Mullol J, Sastre J, Valero A. Bilastine for the treatment of urticaria. Expert Opin Pharmacother 2013; 14:1537-44. [DOI: 10.1517/14656566.2013.800044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Sadaba B, Azanza JR, Gomez-Guiu A, Rodil R. Critical appraisal of bilastine for the treatment of allergic rhinoconjunctivitis and urticaria. Ther Clin Risk Manag 2013; 9:197-205. [PMID: 23667312 PMCID: PMC3650569 DOI: 10.2147/tcrm.s16079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Indexed: 01/18/2023] Open
Abstract
Bilastine is a second generation antihistamine indicated for the treatment of seasonal or perennial allergic rhinoconjunctivitis and chronic urticaria with a daily dose of 20 mg, in adults and children over 12 years of age. The efficacy of bilastine has been shown to be similar to that of the comparator drugs for the control of the nasal and nonnasal symptoms of allergic rhinoconjunctivitis, while also showing a subjective improvement in the quality of life and in overall clinical impression. For chronic urticaria the symptoms (itching and the development of papules) lessens from the second day of treatment onwards, in a similar way to other antihistamines used as comparators. Bilastine should not be administered at meal times to avoid interference with the absorption process. It is not distributed to the central nervous system, is scarcely metabolized, and elimination is through the kidneys and feces, with a 14-hour elimination half-life. It has no effect on cytochrome P450. During clinical development, bilastine was shown to be a drug that is adequately tolerated, with a similar effect to placebo with regard to drowsiness and changes in heart rate. In relation to its use, headaches were the most frequent adverse effect to be reported. No cardiotoxic effects have been observed, and the therapeutic dose does not alter the state of alertness.
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Affiliation(s)
- Belen Sadaba
- Clinical Pharmacology Service, Clinica Universidad de Navarra, Navarra, Spain
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Gentile D, Bartholow A, Valovirta E, Scadding G, Skoner D. Current and future directions in pediatric allergic rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:214-26; quiz 227. [PMID: 24565478 DOI: 10.1016/j.jaip.2013.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/22/2013] [Accepted: 03/23/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications. OBJECTIVE The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR. METHODS Literature reviews in each of these areas were conducted, and the results were incorporated. RESULTS The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy. CONCLUSIONS In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.
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Affiliation(s)
- Deborah Gentile
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa
| | - Ashton Bartholow
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa
| | | | - Glenis Scadding
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - David Skoner
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa.
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Abstract
Bilastine is an orally administered, second-generation antihistamine used in the symptomatic treatment of seasonal or perennial allergic rhinoconjunctivitis and urticaria. In two well designed phase III trials, 14 days' treatment with bilastine was associated with a significantly lower area under the effect curve (AUEC) for the reflective total symptom score (TSS) than placebo in patients with symptomatic seasonal allergic rhinitis. Additionally, reflective nasal symptom scores were significantly lower in bilastine than placebo recipients in patients with a history of seasonal allergic rhinitis who were challenged with grass pollen allergen in a single-centre, phase II study. Neither bilastine nor cetirizine was effective in the treatment of perennial allergic rhinitis with regard to the mean AUEC for reflective TSS in another well designed phase III trial. However, results may have been altered by differences in some baseline characteristics and placebo responses between study countries. In another well designed phase III trial, compared with placebo, bilastine was associated with a significantly greater change from baseline to day 28 in the mean reflective daily urticaria symptom score in patients with chronic urticaria. There were no significant differences in primary endpoint results between bilastine and any of the active comparators used in these trials (i.e. cetirizine, levocetirizine and desloratadine). Bilastine was generally well tolerated, with a tolerability profile that was generally similar to that of the other second-generation antihistamines included in phase III clinical trials.
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Graff C, Struijk JJ, Kanters JK, Andersen MP, Toft E, Tyl B. Effects of bilastine on T-wave morphology and the QTc interval: a randomized, double-blind, placebo-controlled, thorough QTc study. Clin Drug Investig 2012; 32:339-51. [PMID: 22393898 DOI: 10.2165/11599270-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The International Conference of Harmonisation (ICH) E14 guideline for thorough QT studies requires assessing the propensity of new non-antiarrhythmic drugs to affect cardiac repolarization. The present study investigates whether a composite ECG measure of T-wave morphology (Morphology Combination Score [MCS]) can be used together with the heart rate corrected QT interval (QTc) in a fully ICH E14-compliant thorough QT study to exclude clinically relevant repolarization effects of bilastine, a novel antihistamine. METHODS Thirty participants in this crossover study were randomly assigned to receive placebo, moxifloxacin 400 mg, bilastine at therapeutic and supratherapeutic doses (20 and 100 mg) and bilastine 20 mg co-administered with ketoconazole 400 mg. Resting ECGs recorded at 12 nominal time points before and after treatments were used to determine Fridericia corrected QTc (QTcF) and MCS from the T-wave characteristics: asymmetry, flatness and notching. RESULTS There were no effects of bilastine monotherapy (20 and 100 mg) on MCS or QTcF at those study times where the bilastine plasma concentrations were highest. MCS changes for bilastine monotherapy did not exceed the normal intrasubject variance of T-wave shapes for triplicate ECG recordings. Maximum QTcF prolongation for bilastine monotherapy was 5 ms or less: 3.8 ms (90% CI 0.3, 7.3 ms) for bilastine 20 mg and 5.0 ms (90% CI 2.0, 8.0 ms) for bilastine 100 mg. There were no indications of bilastine inducing larger repolarization effects on T-wave morphology as compared with the QTcF interval, as evidenced by the similarity of z-score equivalents for placebo-corrected changes in MCS and QTcF values. CONCLUSION This study shows that bilastine, at therapeutic and supratherapeutic dosages, does not induce any effects on T-wave morphology or QTcF. These results confirm the absence of an effect for bilastine on cardiac repolarization.
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Affiliation(s)
- Claus Graff
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Jáuregui I, García-Lirio E, Soriano AM, Gamboa PM, Antépara I. An overview of the novel H1-antihistamine bilastine in allergic rhinitis and urticaria. Expert Rev Clin Immunol 2012; 8:33-41. [PMID: 22149338 DOI: 10.1586/eci.11.87] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Currently available second-generation H1-antihistamines include a wide group of drugs with a better therapeutic index (or risk-benefit ratio) than the classic antihistamines, although their properties and safety profiles may differ. Bilastine is a newly registered H1-antihistamine for the oral treatment of allergic rhinitis and urticaria, with established antihistaminic and antiallergic properties. Clinical studies in allergic rhinitis and chronic urticaria show that once-daily treatment with bilastine 20 mg is effective in managing symptoms and improving patient's quality of life, with at least comparable efficacy to other nonsedative H1-antihistamines. As far as studies in healthy volunteers, clinical assays and clinical experience can establish, bilastine's safety profile is satisfactory, since it lacks anticholinergic effects, does not impair psychomotor performance or actual driving, and appears to be entirely free from cardiovascular effects.
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Affiliation(s)
- Ignacio Jáuregui
- Servicio de Alergia-Hospital de Basurto, Avenida de Montevideo, 18-48013 Bilbao, Spain.
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