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Alissa I, Nair AB, Aldhubiab B, Shah H, Shah J, Mewada V, Almuqbil RM, Jacob S. Design, Development, and Evaluation of Treprostinil Embedded Adhesive Transdermal Patch. Pharmaceutics 2023; 15:pharmaceutics15041226. [PMID: 37111710 PMCID: PMC10146406 DOI: 10.3390/pharmaceutics15041226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Clinical application of treprostinil in pulmonary arterial hypertension is hampered by adverse effects caused by its high dosing frequency. The objective of this investigation was to Formulate an adhesive-type transdermal patch of treprostinil and evaluate it both in vitro and in vivo. A 32-factorial design was utilized to optimize the selected independent variables (X1: drug amount, X2: enhancer concentration) on the response variables (Y1: drug release, Y2: transdermal flux). The optimized patch was evaluated for various pharmaceutical properties, skin irritation, and pharmacokinetics in rats. Optimization results signify considerable influence (p < 0.0001) of X1 on both Y1 and Y2, as compared to X2. The optimized patch possesses higher drug content (>95%), suitable surface morphology, and an absence of drug crystallization. FTIR analysis revealed compatibility of the drug with excipients, whereas DSC thermograms indicate that the drug exists as amorphous in the patch. The adhesive properties of the prepared patch confirm adequate adhesion and painless removal, while the skin irritation study confirms its safety. A steady drug release via Fickian diffusion and greater transdermal delivery (~23.26 µg/cm2/h) substantiate the potential of the optimized patch. Transdermal therapy resulted in higher treprostinil absorption (p < 0.0001) and relative bioavailability (237%) when compared to oral administration. Overall, the results indicate that the developed drug in the adhesive patch can effectively deliver treprostinil through the skin and could be a promising treatment option for pulmonary arterial hypertension.
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Affiliation(s)
- Ibrahim Alissa
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Anroop B Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Bandar Aldhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Hiral Shah
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Jigar Shah
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India
| | - Vivek Mewada
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India
| | - Rashed M Almuqbil
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
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Alhumaid S, Al Mutair A, Busubaih JS, Al Dossary N, Alsuliman M, Baltyour SA, Alissa I, Al Hassar HI, Al Aithan NA, Albassri HA, AlOmran SA, ALGhazal RM, Busbaih A, Alsalem NA, Alagnam W, Alyousef MY, Alseffay AU, Al Aish HA, Aldiaram A, Al Eissa HA, Alhumaid MA, Bukhamseen AN, Al Mutared KM, Aljwisim AH, Twibah AM, AlSaeed MM, Alkhalaf HA, ALShakhs FM, Koritala T, Al-Tawfiq JA, Dhama K, Rabaan AA, Al-Omari A. Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis. Infect Agent Cancer 2022; 17:49. [PMID: 36096812 PMCID: PMC9466313 DOI: 10.1186/s13027-022-00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Patients with colorectal cancer (CRC) are more likely to develop severe course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and experience increased risk of mortality compared to SARS-CoV-2 patients without CRC. Objectives To estimate the prevalence of SARS-CoV-2 infection in CRC patients and analyse the demographic parameters, clinical characteristics and treatment outcomes in CRC patients with COVID-19 illness. Methods For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature for studies on the incidence of SARS-CoV-2 infection in CRC patients, published from December 1, 2019 to December 31, 2021, with English language restriction. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). Sub-group analyses were performed to minimize heterogeneity. Binary logistic regression model was used to explore the effect of various demographic and clinical characteristics on patient’s final treatment outcome (survival or death). Results Of the 472 papers that were identified, 69 articles were included in the systematic review and meta-analysis (41 cohort, 16 case-report, 9 case-series, 2 cross-sectional, and 1 case-control studies). Studies involving 3362 CRC patients with confirmed SARS-CoV-2 (all patients were adults) were analyzed. The overall pooled proportions of CRC patients who had laboratory-confirmed community-acquired and hospital-acquired SARS-CoV-2 infections were 8.1% (95% CI 6.1 to 10.1, n = 1308, 24 studies, I2 98%, p = 0.66), and 1.5% (95% CI 1.1 to 1.9, n = 472, 27 studies, I2 94%, p < 0.01). The median patient age ranged from 51.6 years to 80 years across studies. The majority of the patients were male (n = 2243, 66.7%) and belonged to White (Caucasian) (n = 262, 7.8%), Hispanic (n = 156, 4.6%) and Asian (n = 153, 4.4%) ethnicity. The main source of SARS-CoV-2 infection in CRC patients was community-acquired (n = 2882, 85.7%; p = 0.014). Most of those SARS-CoV-2 patients had stage III CRC (n = 725, 21.6%; p = 0.036) and were treated mainly with surgical resections (n = 304, 9%) and chemotherapies (n = 187, 5.6%), p = 0.008. The odd ratios of death were significantly high in patients with old age (≥ 60 years) (OR 1.96, 95% CI 0.94–0.96; p < 0.001), male gender (OR 1.44, 95% CI 0.41–0.47; p < 0.001) CRC stage III (OR 1.54, 95% CI 0.02–1.05; p = 0.041), CRC stage IV (OR 1.69, 95% CI 0.17–1.2; p = 0.009), recent active treatment with chemotherapies (OR 1.35, 95% CI 0.5–0.66; p = 0.023) or surgical resections (OR 1.4, 95% CI 0.8–0.73; p = 0.016) and admission to ICU (OR 1.88, 95% CI 0.85–1.12; p < 0.001) compared to those who survived. Conclusion SARS-CoV-2 infection in CRC patient is not uncommon and results in a mortality rate of 26.2%. Key determinants that lead to increased mortality in CRC patients infected with COVID-19 include older age (≥ 60 years old); male gender; Asian and Hispanic ethnicity; if SARS-CoV-2 was acquired from hospital source; advanced CRC (stage III and IV); if patient received chemotherapies or surgical treatment; and if patient was admitted to ICU, ventilated or experienced ARDS.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, Australia
| | - Jawad S Busubaih
- Gastroenterology Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Murtadha Alsuliman
- Department of Pharmacy, Hereditary Blood Diseases Centre, Al-Ahsa, Saudi Arabia
| | - Sarah A Baltyour
- Infection Prevention and Control Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Ibrahim Alissa
- Pharmaceutical Care Department, Prince Sultan Cardiac Centre, Al-Ahsa, Saudi Arabia
| | | | - Noor A Al Aithan
- Intensive Care Unit, Omran General Hospital, Al-Ahsa, Saudi Arabia
| | - Hani A Albassri
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa, Saudi Arabia
| | - Suliman A AlOmran
- Pharmacy Department, King Faisal General Hospital, Al-Ahsa, Saudi Arabia
| | - Raed M ALGhazal
- Department of Gastroenterology, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed Busbaih
- Critical Care Medicine/Gastroenterology Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Nasser A Alsalem
- Department of Critical Care, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Waseem Alagnam
- Department of Critical Care, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Y Alyousef
- Administration of Academic Affairs and Research, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | | | - Ali Aldiaram
- Pharmaceutical Care Department, Prince Sultan Cardiac Centre, Al-Ahsa, Saudi Arabia
| | - Hisham A Al Eissa
- Medical Services Department, King Fahad Hofuf Hospital, Al-Ahsa, Saudi Arabia
| | | | - Ali N Bukhamseen
- Pharmacy Department, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia
| | - Koblan M Al Mutared
- Administration of Pharmaceutical Care, Ministry of Health, Najran, Saudi Arabia
| | - Abdullah H Aljwisim
- Administration of Compliance, Al-Ahsa Health Affairs, Ministry of Health, Al‑Ahsa, Saudi Arabia
| | - Abdullah M Twibah
- Administration of Compliance, Al-Ahsa Health Affairs, Ministry of Health, Al‑Ahsa, Saudi Arabia
| | - Meteab M AlSaeed
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hussien A Alkhalaf
- Pharmacy Department, Al Jaber Hospital for Eye, Ear, Nose and Throat, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Thoyaja Koritala
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, 243122, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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