Reducing cardiovascular risk in immune-mediated inflammatory diseases: Tumour necrosis factor inhibitors compared to conventional therapies-A systematic review and meta-analysis

Immune-mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)-α-mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case-control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random-effects meta-analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non-biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta-analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58-0.95, p = 0.025; IRR = 0.77, 95% CI 0.67-0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi-treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64-0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.

Trends in Opioid Utilisation in Hungary, 2006-2020: A Nationwide Retrospective Study with Multiple Metrics

BACKGROUND

Opioid use is well-documented in several countries: some countries struggle with overuse while others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilisation in ambulatory care between 2006 and 2020.

METHODS

We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilisation trends, using three volume-based metrics (defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year). We stratified data based on administration routes, analgesic potency and reimbursement categories.

RESULTS

Total opioid utilisation increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID).

CONCLUSIONS

Our low utilisation numbers might indicate underuse of opioid analgesia, especially for cancer pain.

Assessment of proarrhythmogenic risk for cannabidiol using dog and rabbit cardiac preparations: the electrophysiological effects on action potential and transmembrane potassium currents

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Economic Development and Innovation Operative Programme GINOP-2.3.2-15-2016-00012, the National Research Development and Innovation Office (NKFIH K 135464 and NKFIH K 128851), the Ministry of Human Capacities Hungary (20391-3/2018/FEKUSTRAT and EFOP-3.6.2-16-2017-00006), and from the Eötvös Loránd Research Network

Background

Cannabidiol (CBD), a major active phytogenic cannabinoid, is one of the main constituents of cannabis. Cannabis has been widely used as recreational drug over the decades and its use is constantly increasing as hallucinogenic and/or medicinal agent. However, significant cardiovascular side effects can accompany its use ranging from arrhythmia to sudden cardiac death.

Purpose

The aim of the present work was to investigate the possible cardiac adverse electrophysiological effects of cannabidiol (CBD) on action potentials and various transmembrane potassium currents, such as the rapid (IKr) and slow (IKs) delayed rectifier, the transient outward (Ito) and inward rectifier (IK1) potassium currents in rabbit and dog cardiac preparations to assess the cardiac safety profile and proarrhythmic risk.

Methods

In the current study, conventional microelectrode and voltage clamp techniques were used to record the action potential and transmembrane ionic currents in dog and rabbit ventricular tissue preparations and enzymatically isolated myocytes, respectively.

Results

The results show that CBD lengthens APD90 significantly at the concentration of 5 µM both in dog and rabbit ventricular tissues without changing other action potential parameters significantly. To further investigate the APD90 lengthening effect of CBD, transmembrane potassium currents (IKr, IKs, Ito and IK1) were investigated in dog and/or rabbit ventricular myocytes using voltage clamp technique. CBD significantly inhibited IKr and IKs currents in rabbit ventricular myocytes with an estimated EC50 values of 4.9 and 3.1 µM, respectively. The effect of CBD on rabbit’s Ito current was not significant while it was significant on dog’s Ito current with an estimated EC50 value of 5 µM. IK1 was not responsive to CBD even at high concentration.

Conclusion

In conclusion, looking at the inhibitory effects of CBD on repolarizing potassium currents, despite of the fact that these calculated EC50 values are higher than pharmacokinetics based Cmax values of CBD recorded after smoking and oral intake, it can be speculated that in the presence of certain cardio active drugs or co-morbidity where CBD metabolism or cardiac repolarization reserve is impaired CBD can have an additive and proarrhythmic effect.

Rapid identification of sibutramine in dietary supplements using a stepwise approach

Adulteration of botanical food supplements with undeclared synthetic drugs is a common problem. One of the most affected product groups are the slimming agents. There are no analytical protocols for the detection of synthetic adulterants from these products. The present study aimed at the development of a multistep analytical method for the quick and reliable determination of sibutramine, one of the most common adulterants among botanical food supplements. The extract of a sibutramine-containing slimming formula was analysed by colour tests, TLC, HPLC-DAD, MS and NMR. The multistep method proposed by the authors allows the quick identification of sibutramine in counterfeit samples in laboratories with different instrumentation.