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Abstract
Introduction: Bempedoic acid is a first-in-class low-density lipoprotein cholesterol (LDL-C) lowering agent which offers an important opportunity for further LDL-C lowering in statin-intolerant patients or in patients requiring further LDL-C reduction despite maximally tolerated statin therapy.Areas covered: In this review, we examined the pharmacodynamics, pharmacokinetics, clinical efficacy, and safety of bempedoic acid, based on randomized clinical phase III clinical studies and their meta-analyses.Expert opinion: Unlike statins, bempedoic acid is administered as a prodrug and is converted to active form by a liver-specific enzyme. For the liver-specific mechanism of action, bempedoic acid has the potential to reduce the risk of muscle-related adverse events which can limit the utilization and effectiveness of statin therapy.
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Affiliation(s)
- Arrigo F G Cicero
- IRCCS AOU S. Orsola-Malpighi, Hypertension and Cardiovascular Risk Factors Research Center (DIMEC), University of Bologna, Bologna, Italy
| | - Federica Fogacci
- IRCCS AOU S. Orsola-Malpighi, Hypertension and Cardiovascular Risk Factors Research Center (DIMEC), University of Bologna, Bologna, Italy
| | - Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Chierici A, Ofosu A, Cincione I, Sacco R, Cotsoglou C, Facciorusso A. Transarterial chemoembolization as adjuvant treatment after surgery: The cure of huge hepatocellular carcinoma? Hepatobiliary Pancreat Dis Int 2021; 20:205-206. [PMID: 33342662 DOI: 10.1016/j.hbpd.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/12/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Andrea Chierici
- General Surgery Department, ASST-Vimercate, Vimercate 20871, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Rodolfo Sacco
- Department of Surgical and Medical Sciences, Gastroenterology Unit, University of Foggia, Viale Pinto, 1, Foggia 71122, Italy
| | | | - Antonio Facciorusso
- Department of Surgical and Medical Sciences, Gastroenterology Unit, University of Foggia, Viale Pinto, 1, Foggia 71122, Italy.
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Facciorusso A, Cincione I, Sacco R. Comparison of Tenofovir and Entecavir in the Prevention of Hepatocellular Carcinoma Occurrence in Patients with Chronic Hepatitis B. Liver Cancer 2021; 10:285-286. [PMID: 34239814 PMCID: PMC8237790 DOI: 10.1159/000512780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Foggia, Italy,*Antonio Facciorusso, Department of Medical Sciences, Gastroenterology Unit, AOU Ospedali Riuniti, Viale Pinto, 1, IT–71122 Foggia (Italy),
| | - Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sacco
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Foggia, Italy
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Facciorusso A, Chierici A, Cincione I, Sacco R, Ramai D, Mohan BP, Chandan S, Ofosu A, Cotsoglou C. Stereotactic body radiotherapy vs radiofrequency ablation for the treatment of hepatocellular carcinoma: a meta-analysis. Expert Rev Anticancer Ther 2021; 21:681-688. [PMID: 33590783 DOI: 10.1080/14737140.2021.1891887] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: There are limited and discording results on the comparison between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). The aim of this meta-analysis was to compare the two treatments in terms of efficacy and safety.Research design and methods: A bibliographic search was performed on main databases through September 2020. Primary outcome was recurrence-free survival. Overall survival and adverse event rates were the secondary outcomes. Results were expressed as odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI)Results: Nine studies enrolling 6545 patients were included. Recurrence-free survival at 1-year was similar between the two treatments (OR 2.11, 0.67-6.63); recurrence-free survival at 2- and 3-year was significantly in favor of SBRT as compared to RFA (OR 2.06, 1.48-2.88 and 1.86, 1.07-3.26, respectively). In a meta-analysis of plotted HRs, SBRT significantly outperformed RFA (HR 0.50, 0.33-0.76, p = 0.001). Overall survival was similar between the two treatments (HR 1.03, 0.72-1.47). No significant difference in terms of severe adverse event rate was observed (OR 1.38, 0.28-6.71).Conclusions: SBRT prolongs recurrence-free survival as compared to RFA in HCC patients, although no significant survival benefit was demonstrated.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Andrea Chierici
- General Surgery Department, ASST-Vimercate, Vimercate, Italy
| | - Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sacco
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Daryl Ramai
- Gastroenterology and Hepatology, Brooklyn Hospital Medical Center, Brooklyn, NY, USA
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Saurabh Chandan
- Gastroenterology Unit, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, Johns Hopkins University Hospital, Baltimore, MD, USA
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Facciorusso A, Abd El Aziz MA, Cincione I, Cea UV, Germini A, Granieri S, Cotsoglou C, Sacco R. Angiotensin Receptor 1 Blockers Prolong Time to Recurrence after Radiofrequency Ablation in Hepatocellular Carcinoma patients: A Retrospective Study. Biomedicines 2020; 8:E399. [PMID: 33050084 PMCID: PMC7599746 DOI: 10.3390/biomedicines8100399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/06/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. Aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. Data on 215 patients were reviewed. The study population was classified into three groups: 113 (52.5%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 59 (27.4%) patients treated with angiotensin-converting enzyme inhibitors (group 2) and 43 (20.1%) patients treated with sartans (group 3). Survival outcomes were analyzed using Kaplan-Meier analysis and compared with log-rank test. In the whole study population, 85.6% of patients were in Child-Pugh A-class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10-40 mm) and alpha-fetoprotein was 25 (1.1-2100) IU/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (42-51) in group 1, 51 months (42-88) in group 2, and 63 months (51-84) in group 3 (p = 0.15). Child-Pugh stage and Model for End-staging Liver Disease (MELD) score resulted as significant predictors of overall survival in multivariate analysis. Median time to recurrence was 33 months (24-35) in group 1, 41 (23-72) in group 2 and 51 months (42-88) in group 3 (p = 0.001). Number of nodules and anti-angiotensin treatment were confirmed as significant predictors of time to recurrence in multivariate analysis. Sartans significantly improved time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients but did not improve overall survival.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
| | | | - Ivan Cincione
- Department of Clinical and Experimental Medicine, Faculty of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Ugo Vittorio Cea
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
| | - Alessandro Germini
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Stefano Granieri
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Christian Cotsoglou
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Rodolfo Sacco
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
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