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Dahl M, Gerhardsson E, Lafolie P, Allard A, Laurell CG. More symptoms with sialic receptor-positive adenovirus in epidemic keratoconjunctivitis. Acta Ophthalmol 2016; 94:e375-6. [PMID: 26523611 DOI: 10.1111/aos.12892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Madeleine Dahl
- Department of Clinical Neuroscience, Ophtalmology and Vision; Karolinska Institutet; St. Erik Eye Hospital; Stockholm Sweden
| | | | - Pierre Lafolie
- Unit of Clinical Pharmacology; Department of Medicine - Solna; Karolinska Institutet; Stockholm Sweden
| | - Annika Allard
- Laboratory Medicine Department of Clinical Microbiology; University Hospital of Northern Sweden; Umeå Sweden
| | - Carl-Gustaf Laurell
- Department of Clinical Neuroscience, Ophtalmology and Vision; Karolinska Institutet; St. Erik Eye Hospital; Stockholm Sweden
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Fotoohi AK, Karim H, Lafolie P, Pohanka A, Östervall J, Hatschek T, Vitols S. Pronounced Interindividual But Not Intraindividual Variation in Tamoxifen and Metabolite Levels in Plasma During Adjuvant Treatment of Women With Early Breast Cancer. Ther Drug Monit 2016; 38:239-45. [DOI: 10.1097/ftd.0000000000000257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ludvigsson JF, Håberg SE, Knudsen GP, Lafolie P, Zoega H, Sarkkola C, von Kraemer S, Weiderpass E, Nørgaard M. Ethical aspects of registry-based research in the Nordic countries. Clin Epidemiol 2015; 7:491-508. [PMID: 26648756 PMCID: PMC4664438 DOI: 10.2147/clep.s90589] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
National health care registries in the Nordic countries share many attributes, but different legal and ethical frameworks represent a challenge to promoting effective joint research. Internationally, there is a lack of knowledge about how ethical matters are considered in Nordic registry-based research, and a lack of knowledge about how Nordic ethics committees operate and what is needed to obtain an approval. In this paper, we review ethical aspects of registry-based research, the legal framework, the role of ethics review boards in the Nordic countries, and the structure of the ethics application. We discuss the role of informed consent in registry-based research and how to safeguard the integrity of study participants, including vulnerable subjects and children. Our review also provides information on the different government agencies that contribute registry-based data, and a list of the major health registries in Denmark, Finland, Iceland, Norway, and Sweden. Both ethical values and conditions for registry-based research are similar in the Nordic countries. While Denmark, Finland, Iceland, Norway, and Sweden have chosen different legal frameworks, these differences can be resolved through mutual recognition of ethical applications and by harmonizing the different systems, likely leading to increased collaboration and enlarged studies.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | | | | | - Pierre Lafolie
- Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, Stockholm, Sweden ; The Stockholm Regional Ethical Review Board, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Catharina Sarkkola
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | | | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland ; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway ; The Arctic University of Norway, Tromsø, Norway ; Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Lafolie P, Agahi N. [Ethical review of research in the grey area. The Ethical Review Act should be widened and case management more efficient]. Lakartidningen 2015; 112:C9CL. [PMID: 25710225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The present legal definition of the term research creates problems with what can be considered for ethical vetting by the Research Ethical Review Board. The Ethical Review Act should be revised in order for student projects involving patients or quality assurance in healthcare to be accepted for ethical vetting by the Board.
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Affiliation(s)
- Pierre Lafolie
- Clinical Pharmacology - Dep of Medicine - Solna Stockholm, Sweden Clinical Pharmacology - Dep of Medicine - Solna Stockholm, Sweden
| | - Neda Agahi
- Aging Research Center (ARC) - Karolinska Institutet Stockholm, Sweden Aging Research Center (ARC) - Karolinska Institutet Stockholm, Sweden
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Neimert-Andersson T, Binnmyr J, Enoksson M, Langebäck J, Zettergren L, Hällgren AC, Franzén H, Lind Enoksson S, Lafolie P, Lindberg A, Al-Tawil N, Andersson M, Singer P, Grönlund H, Gafvelin G. Evaluation of safety and efficacy as an adjuvant for the chitosan-based vaccine delivery vehicle ViscoGel in a single-blind randomised Phase I/IIa clinical trial. Vaccine 2014; 32:5967-74. [DOI: 10.1016/j.vaccine.2014.08.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 11/30/2022]
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Boeynaems JM, Canivet C, Chan A, Clarke MJ, Cornu C, Daemen E, Demotes J, Nys KD, Hirst B, Hundt F, Kassai B, Kerpel-Fronius S, Kiessig L, Klech H, Kraehenbuhl JP, Lafolie P, Lucht M, Niese D, Pauli-Magnus C, Peters B, Schaltenbrand R, Stockis A, Stykova M, Verheus N, Klingmann I. A European approach to clinical investigator training. Front Pharmacol 2013; 4:112. [PMID: 24058345 PMCID: PMC3766792 DOI: 10.3389/fphar.2013.00112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/19/2013] [Indexed: 12/03/2022] Open
Abstract
A better education and training of clinical investigators and their teams is one of the factors that could foster the development of clinical research in Europe, a key objective of the Innovative Medicines Initiative (IMI). PharmaTrain (an IMI programme on training in medicines development), and European Clinical Research Infrastructures Network (ECRIN) have joined forces to address this issue. An advisory group composed of representatives of universities, pharmaceutical companies and other organisations met four times between June 2011 and July 2012. This resulted in a position paper proposing a strategy to improve and harmonize clinical investigator training in Europe, and including a detailed syllabus and list of learning outcomes. Major recommendations are the establishment of minimal and mutually recognized certification requirement for investigators throughout the EU and the creation of a European platform to provide a suitable course and examination infrastructure.
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Karim H, Bogason A, Bhuiyan H, Fotoohi A, Lafolie P, Vitols S. Comparison of Uptake Mechanisms for Anthracyclines in Human Leukemic Cells. Curr Drug Deliv 2013; 10:404-12. [DOI: 10.2174/1567201811310040005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/25/2012] [Accepted: 10/05/2012] [Indexed: 11/22/2022]
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Karim H, Ghalali A, Lafolie P, Vitols S, Fotoohi AK. Differential role of thiopurine methyltransferase in the cytotoxic effects of 6-mercaptopurine and 6-thioguanine on human leukemia cells. Biochem Biophys Res Commun 2013; 437:280-6. [PMID: 23811272 DOI: 10.1016/j.bbrc.2013.06.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 11/24/2022]
Abstract
The thiopurine antimetabolites, 6-mercaptopurine (6-MP) and 6-thioguanine (6-TG) are inactive pro-drugs that require intracellular metabolism for activation to cytotoxic metabolites. Thiopurine methyltransferase (TPMT) is one of the most important enzymes in this process metabolizing both 6-MP and 6-TG to different methylated metabolites including methylthioinosine monophosphate (meTIMP) and methylthioguanosine monophosphate (meTGMP), respectively, with different suggested pharmacological and cytotoxic properties. While meTIMP is a potent inhibitor of de novo purine synthesis (DNPS) and significantly contributes to the cytotoxic effects of 6-MP, meTGMP, does not add much to the effects of 6-TG, and the cytotoxicity of 6-TG seems to be more dependent on incorporation of thioguanine nucleotides (TGNs) into DNA rather than inhibition of DNPS. In order to investigate the role of TPMT in metabolism and thus, cytotoxic effects of 6-MP and 6-TG, we knocked down the expression of the gene encoding the TPMT enzyme using specifically designed small interference RNA (siRNA) in human MOLT4 leukemia cells. The knock-down was confirmed at RNA, protein, and enzyme function levels. Apoptosis was determined using annexin V and propidium iodide staining and FACS analysis. The results showed a 34% increase in sensitivity of MOLT4 cells to 1μM 6-TG after treatment with TPMT-targeting siRNA, as compared to cells transfected with non-targeting siRNA, while the sensitivity of the cells toward 6-MP was not affected significantly by down-regulation of the TPMT gene. This differential contribution of the enzyme TPMT to the cytotoxicity of the two thiopurines is probably due to its role in formation of the meTIMP, the cytotoxic methylated metabolite of 6-MP, while in case of 6-TG methylation by TPMT substantially deactivates the drug.
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Affiliation(s)
- Hazhar Karim
- Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Ehrén I, Hallén Grufman K, Vrba M, Sundelin R, Lafolie P. Nitric oxide as a marker for evaluation of treatment effect of cyclosporine A in patients with bladder pain syndrome/interstitial cystitis type 3C. Scand J Urol 2013; 47:503-8. [PMID: 23600529 DOI: 10.3109/21681805.2013.788552] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic inflammatory disease and to date few treatments or tools for investigating the activity of the disease are available. This study evaluated whether luminal nitric oxide (NO) could be used as a marker for evaluation of therapeutic outcome in BPS/IC type 3C treated with the immunosuppressive agent cyclosporine A (CsA). MATERIAL AND METHODS Ten patients with BPS/IC type 3C were given CsA for 16 weeks, initially at 3 mg/kg/day, and after 12 weeks the dose was scaled down. Formation of NO was measured in the urinary bladder with a silicone catheter, and symptom and bother score related to the disease were evaluated with the Interstitial Cystitis Symptom and Problem Index, every second week. RESULTS All patients had elevated NO levels in the bladder initially and NO levels decreased during treatment with CsA. When the dose of CsA was lowered NO formation increased and after 2 weeks without medication, the NO formation was the same as before the study began. CONCLUSIONS The results indicate that measurement of NO is a tool for evaluating the response to anti-inflammatory treatment in patients with BPS/IC type 3C. NO could serve as a marker for assessing the activity of the inflammation.
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Bogason A, Quartino AL, Lafolie P, Masquelier M, Karlsson MO, Paul C, Gruber A, Vitols S. Inverse relationship between leukaemic cell burden and plasma concentrations of daunorubicin in patients with acute myeloid leukaemia. Br J Clin Pharmacol 2011; 71:514-21. [PMID: 21204910 DOI: 10.1111/j.1365-2125.2010.03894.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS It has been shown that the cellular uptake and cytotoxicity of anthracyclines decrease with increasing cell density in vitro, an event termed 'the inocculum effect'. It is not known whether such an effect occurs in vivo. In this study the relationships between white blood cell (WBC) count, plasma and cellular concentrations of daunorubicin (DNR) in patients with acute myeloid leukaemia were investigated. METHODS Plasma and mononuclear blood cells were isolated from peripheral blood from 40 patients with acute myeloid leukaemia at end of infusion (time 1 h), 5 and 24 h following the first DNR infusion. DNR concentrations were determined by high-pressure liquid chromatography and related to the WBC count at diagnosis. A population pharmacokinetic model was used to estimate the correlations between baseline WBC count, volume of distribution and clearance of DNR. RESULTS A clear but weak inverse relationship between the baseline WBC count and plasma concentrations of DNR (r(2)=0.11, P<0.05) at time 1 was found. Furthermore, a clear relationship between baseline WBC count and DNR central volume of distribution using population pharmacokinetic modelling (dOFV 4.77, P<0.05) was also noted. Analysis of plasma DNR and the metabolite daunorubicinol (DOL) concentrations in patients with a high WBC count support that the low DNR/DOL concentrations are due a distribution effect. CONCLUSION This study shows that the leukaemic cell burden influences the plasma concentrations of anthracyclines. Further studies are needed to explore if patients with high a WBC count may require higher doses of anthracyclines.
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Affiliation(s)
- Alex Bogason
- Departments of Medicine, Divisions of Clinical Pharmacology, Karolinska Institute/Karolinska University Hospital, Solna S-171 76, Stockholm, Sweden
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Bogason A, Masquelier M, Lafolie P, Skogastierna C, Paul C, Gruber A, Vitols S. Daunorubicin metabolism in leukemic cells isolated from patients with acute myeloid leukemia. Drug Metab Lett 2010; 4:228-232. [PMID: 20670211 DOI: 10.2174/187231210792928260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 07/26/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Anthracyclines like daunorubicin (DNR) are important drugs in the treatment of acute myeloid leukaemia (AML). In vitro studies have shown that cellular metabolism of anthracyclines could play a role in drug resistance. Currently, it is not known what enzyme is responsible for anthracycline metabolism in leukemic cells. AIMS To study C-13 reduction of DNR to daunorubicinol (DOL) in leukemic cells isolated from patients with AML and to determine the most important enzyme involved. METHODS Mononuclear blood cells from 25 AML patients were isolated at diagnosis and used in a metabolic assay to determine the % DOL formed. mRNA and western blot analysis were performed on the 2 most likely candidates for anthracycline metabolism; carbonyl reductase 1 (CR1) and aldoketoreductase 1A1 (AKR1A1). DNR and DOL concentrations were determined by HPLC. RESULTS We found a large interindividual variation (up to 47-fold) in leukemic cell DNR metabolism. The specific CR1 inhibitor zeraleone analogue 5 significantly inhibited DNR metabolism with a mean inhibitory effect of 68 %. No correlation between mRNA levels of the enzymes and metabolism were found. Cellular DNR metabolism correlated significantly with CR1 protein expression, determined by western blot, (p < 0.05, R2 = 0,229) while no significant correlation was found with AKR1A1 protein expression. CONCLUSIONS DNR metabolism in AML cells shows a pronounced interindividual variability. Our results support that CR1 is the most important enzyme for conversion of DNR to DOL in AML cells. This information could in the future be used to genotype CR1 and possibly help to individualise dosing.
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Affiliation(s)
- Alex Bogason
- Department of Medicine, Division of Clinical Pharmacology, Karolinska Institute/Karolinska University Hospital, Solna, Stockholm, Sweden
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Johansson H, Souri P, Lafolie P. [EU strikes hard against clinical research--an EU project ECRIN builds bridges for clinical trials]. Lakartidningen 2010; 107:2384-2385. [PMID: 21140569] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Lundeberg S, Stephanson N, Lafolie P, Olsson GL, Stiller CO, Eksborg S. Pharmacokinetics after an intravenous single dose of the opioid ketobemidone in children. Acta Anaesthesiol Scand 2010; 54:435-41. [PMID: 19839946 DOI: 10.1111/j.1399-6576.2009.02135.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ketobemidone is often used as an alternative to morphine in children in the Scandinavian countries. The aim of this clinical trial was to explore the pharmacokinetics of ketobemidone in children because these properties have not been reported previously. METHODS Thirty children, newborn to 10 years, scheduled for elective surgery were included in the trial. Ketobemidone hydrochloride was administered as a single intravenous bolus dose and ketobemidone and norketobemidone concentrations were measured by LC-MS over 8 h. Pharmacokinetic parameters were determined using compartmental methods. RESULTS Six children were excluded from pharmacokinetic analysis because of incomplete blood sampling. The values of ketobemidone clearance (l/h/kg) given as median (range) were 0.84 (0.29-3.0) in Group A (0-90 days), 0.89 (0.55-1.35) in Group B (1-2.5 years) and 0.74 (0.50-0.99) in Group C (7-10 years). The corresponding values for apparent volume of distribution (l/kg) were 4.4 (3.7-6.9) (Group A), 2.6 (2.0-5.6) (Group B) and 3.9 (2.7-5.0 (Group C), and for elimination half-life (h) 3.0 (1.4-8.9) (Group A), 2.0 (1.2-4.7) (Group B) and 3.7 (2.4-6.9) (Group C), respectively. In the two neonates the elimination half-life was almost 9 h. The metabolite norketobemidone did not reach levels above the limit of quantification (0.07 ng/ml) in any of the patients. CONCLUSION The pharmacokinetic parameters of ketobemidone in children older than 1 month appear to be similar to those in adults. Because of the large interindividual variability of the pharmacokinetics in neonates, further studies especially in this age group are warranted.
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Affiliation(s)
- S Lundeberg
- Department of Pediatric Anesthesia and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
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Lindelöf B, Lafolie P, Asp P, Forssberg O. [Research without ethical approval occurs--often negligence behind. Review of Karolinska Institute's publications 2006]. Lakartidningen 2009; 106:279-281. [PMID: 19271456] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Kupcinskas L, Lafolie P, Lignell A, Kiudelis G, Jonaitis L, Adamonis K, Andersen LP, Wadström T. Efficacy of the natural antioxidant astaxanthin in the treatment of functional dyspepsia in patients with or without Helicobacter pylori infection: A prospective, randomized, double blind, and placebo-controlled study. Phytomedicine 2008; 15:391-9. [PMID: 18467083 DOI: 10.1016/j.phymed.2008.04.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/10/2008] [Indexed: 05/18/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of the natural antioxidant astaxanthin in functional dyspepsia in different doses and compared with placebo. DESIGN The study was a controlled, prospective, randomized, and double blind trial. PARTICIPANTS Patients with functional dyspepsia, divided into three groups with 44 individuals in each group (placebo, 16mg, or 40mg astaxanthin, respectively). INTERVENTIONS Participants were asked to accept gastroscopy before treatment, together with questionnaires: GSRS and SF-36. Urea breath test (UBT) was done before the treatment. MAIN OUTCOME The primary objective was to test the hypothesis that the antioxidant astaxanthin at two doses regimens compared to placebo should ameliorate gastrointestinal discomfort measured as GSRS in patients with functional dyspepsia, who were either positive or negative for Helicobacter pylori, after 4 weeks of treatment. RESULTS At the end of therapy (week 4) no difference between the three treatment groups was observed regarding mean Gastrointestinal Symptom Rating Scale (GSRS) scores of abdominal pain, indigestion and reflux syndromes. The same results were observed at the end of follow-up. However reduction of reflux syndrome before treatment to week 4 was significantly pronounced in the higher (40mg) dose compared to the other treatment groups (16mg and placebo, p=0.04). CONCLUSION In general, no curative effect of astaxanthin was found in functional dyspepsia patients. Significantly greater reduction of reflux symptoms were detected in patients treated with the highest dose of the natural antioxidant astaxanthin. The response was more pronounced in H. pylori-infected patients.
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Ehren I, Volz D, Farrelly E, Berglund L, Brundin L, Hultling C, Lafolie P. Efficacy and impact of botulinum toxin A on quality of life in patients with neurogenic detrusor overactivity: a randomised, placebo-controlled, double-blind study. ACTA ACUST UNITED AC 2008; 41:335-40. [PMID: 17763227 DOI: 10.1080/00365590601068835] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effect of a single injection of 500 U of botulinum toxin A (BTX-A; Dysport) on use of oral rescue medication, bladder compliance, continence and quality of life in a randomized, placebo-controlled, double-blind study in patients with incontinence due to neurogenic detrusor overactivity. As this group of patients often have severe symptoms, oral tolterodine was allowed as rescue medication and the amount of tolterodine consumed was our primary endpoint. MATERIAL AND METHODS A total of 31 patients with urinary leakage due to spinal cord injury, myelomeningocele, trauma at birth, multiple sclerosis and myelitis of another cause were randomized to intravesical injections of either 500 U of BTX-A or placebo. Intake of tolterodine and episodes of urinary leakage were registered. Cystometry was performed after 6, 12 and 26 weeks and quality of life was assessed. RESULTS Patients in the BTX-A group had a significantly lower intake of tolterodine throughout the study compared to those in the placebo group (p=0.003). Cystometric capacity was significantly higher at 6 (p<0.001) and 12 weeks (p=0.026) and maximum detrusor pressure and frequency of urinary leakage were significantly (p<0.01) lower during follow-up in the BTX-A group compared to the placebo group. In addition, many quality-of-life parameters were significantly improved in the BTX-A group compared to the placebo group. CONCLUSIONS Intravesical injection of 500 U of BTX-A in patients with neurogenic detrusor instability was shown to be an effective treatment which reduced use of oral medication, high detrusor pressure and frequency of urinary leakage during the overall study period of 26 weeks. Quality of life was also significantly improved.
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Affiliation(s)
- Ingrid Ehren
- Department of Urology, Karolinska University Hospital, S-171 76 Stockholm, Sweden.
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Ehren I, Vrba M, Lafolie P. 120: Nitric Oxide as a Marker for Evaluation of Treatment Efficacy of Ciclosporin in Patients with Classic Interstitial Cystitis. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stiller CO, Lundblad H, Weidenhielm L, Tullberg T, Grantinger B, Lafolie P, Jansson KA. The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthroplasty. Acta Anaesthesiol Scand 2007; 51:322-30. [PMID: 17096666 DOI: 10.1111/j.1399-6576.2006.01191.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tramadol is used as an analgesic in post-operative pain treatment. Intravenous tramadol is often combined with morphine to achieve better pain relief and less side-effects after orthopaedic surgery. However, the available evidence is insufficient to support this combination. For this reason, we conducted the present non-commercial, randomized, double-blind clinical trial. METHOD Sixty-three patients with osteoarthritis of the knee, selected for primary total knee arthroplasty (TKA), were randomized to receive saline or tramadol 100 mg/ml intravenously every 6 h during the first post-operative day (total, 400 mg/24 h). All patients had access to morphine via a patient-controlled analgesia (PCA) pump. RESULTS Neither during the 6 h after the first dose nor during the first post-operative day could we detect any statistically significant difference with regard to pain intensity, sedation and nausea between patients treated with tramadol and the placebo group. However, the withdrawal rate caused by insufficient pain relief was greater in the tramadol group (7/31) than in the saline group (2/32). This difference did not reach statistical significance. In the group of patients who remained in the study for 24 h ('per protocol'), those randomized to receive tramadol had a significantly (P < 0.05) lower morphine consumption (20 mg or 31%) than the placebo group. CONCLUSION Our study does not support the combination of tramadol and morphine via PCA for post-operative pain relief after primary TKA. In addition, our study indicates that morphine via PCA as the sole means of post-operative analgesia does not provide sufficient pain relief after TKA. Thus, other means of post-operative analgesia should be used following TKA.
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Affiliation(s)
- C-O Stiller
- Department of Medicine, Clinical Pharmacology, Stockholm, Sweden
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Lafolie P. [Final reply: drug companies must be allowed to make profit]. Lakartidningen 2006; 103:1979. [PMID: 16838588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Lafolie P. [Why has the drug trial at Northwick Park Hospital turned out to a disaster?]. Lakartidningen 2006; 103:1169-70. [PMID: 16696196] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Ehren I, Volz D, Farrelly E, Berglund L, Brundin L, Lafolie P. TREATMENT WITH BOTULINUS TOXIN A IN NEUROGENIC BLADDER DYSFUNCTION -A RANDOMISED DOUBLE-BLIND STUDY WITH DYSPORT. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1569-9056(06)61111-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Lundblad MS, Ohlsson S, Johansson P, Lafolie P, Eliasson E. Accumulation of celecoxib with a 7-fold higher drug exposure in individuals homozygous for CYP2C9*3. Clin Pharmacol Ther 2006; 79:287-8. [PMID: 16513453 DOI: 10.1016/j.clpt.2005.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 11/17/2005] [Indexed: 10/25/2022]
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23
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Lafolie P. [Now no new drugs will be developed!]. Lakartidningen 2006; 103:225. [PMID: 16491556] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Pierre Lafolie
- Klinisk farmakologi, Karolinska Universitetssjukhuset Solna.
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24
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Demotes-Mainard J, Ohmann C, Gluud C, Ch??ne G, Fabris N, Garattini S, Lafolie P, Carn?? X, Collet JP, Crawley F. European Clinical Research Infrastructures Network Meeting Report. ACTA ACUST UNITED AC 2005. [DOI: 10.2165/00124363-200519010-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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25
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Lafolie P. [More stringent requirements concerning clinical research. The new EU rules come into effect on May 1]. Lakartidningen 2004; 101:917-20. [PMID: 15055055] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Pierre Lafolie
- Avdelningen för klinisk farmakologi, Karolinska Universitetssjukhuset Solna.
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26
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Lafolie P. [Reporting of approval by research ethics committee and informed consent should be included in scientific information. A neglected quality indicator]. Lakartidningen 2002; 99:5180-1. [PMID: 12572314] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Pierre Lafolie
- Avdelningen för klinisk farmakologi, Karolinska sjukhuset, Stockholm.
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27
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Lafolie P. [Epidemiology versus clinical trial. A five-round-match on scientific reliability]. Lakartidningen 2002; 99:3132-4. [PMID: 12198935] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Pierre Lafolie
- Avdelningen för klinisk farmakologi, Karolinska sjukhuset, Stockholm.
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28
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Lafolie P, Wallentin L. [Alarm from expert meeting when it comes to Swedish clinical research. "We are no longer as good as our reputation used to be"]. Lakartidningen 2000; 97:4020-1. [PMID: 11036361] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- P Lafolie
- Avdelningen för klinisk farmakologi, Karolinska sjukhuset, Stockholm.
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29
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Abstract
BACKGROUND Clopidogrel is a new antiplatelet agent that offers increased protection over aspirin in preventing vascular ischaemic events in patients with symptomatic atherosclerosis. In a large, randomized, international study of clopidogrel and aspirin (n = 19,185 patients) clopidogrel was associated with a lower incidence of gastrointestinal adverse events, including gastrointestinal haemorrhage and hospitalizations because of gastrointestinal haemorrhage. The aim of the study was to determine whether macroscopic differences in the gastric mucosa between aspirin- and clopidogrel-treated subjects could be detected by gastroscopy after short-term treatment. METHODS Thirty-six healthy volunteers were randomized in a double-blind, double-dummy, parallel design, to 75 mg/day of clopidogrel or 325 mg/day of aspirin for 8 days. Gastroscopy was performed at base line before administration of study drug and directly after treatment completion. Gastroduodenal effects were measured in accordance with a modified Lanza scale. RESULTS At base line no difference between the groups was detected (median Lanza score, 0.0 in both groups). At the end of treatment the aspirin group showed a median score of 7.5, and the clopidogrel group showed an unchanged median score of 0.0 (P < 0.001). In the aspirin group 13 individuals reported 19 adverse events versus 8 individuals and 13 adverse events for clopidogrel, with approximately half of the adverse events being gastrointestinal in each group. No serious adverse events were reported. CONCLUSION In contrast to aspirin, short-term treatment with clopidogrel does not induce macroscopic changes in the gastroduodenal mucosa. The study results show that in patients without gastroduodenal disease clopidogrel, but not aspirin, does not induce any gastroscopically evident erosions during short-term treatment.
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Affiliation(s)
- F T Fork
- Dept. of Diagnostic Radiology, and Sanofi Winthrop, Stockholm, Sweden
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30
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Lafolie P, Beck O, Lin Z, Albertioni F, Boréus L. Urine and plasma pharmacokinetics of codeine in healthy volunteers: implications for drugs-of-abuse testing. J Anal Toxicol 1996; 20:541-6. [PMID: 8934303 DOI: 10.1093/jat/20.7.541] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thirteen healthy volunteers participating in an open and randomized study received two single doses (25 and 50 mg) of codeine orally two weeks apart. Urine concentrations of opiates were studied for 96 h, and plasma concentrations of codeine and the metabolites codeine-6-glucuronide (C6G), morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) were monitored for 24 h. Plasma was analyzed by high-performance liquid chromatography. Measurements of urine were made with the EMIT opiate-screening assay and with gas chromatography-mass spectrometry for total (conjugates liberated by acid hydrolysis) codeine, morphine, and norcodeine. In urine, the ratio between total recovered morphine and codeine as expressed in percent ranged from 2.3 to 23.3% with a mean value of 9.8%. This ratio increased with time, and, in all but three subjects, rose to greater than 1 after 22-36 h. In 58% of cases, this occurred within the detection time in the EMIT assay. The detection time in the EMIT screening assay was found to be 20-39 h after the 25-mg dose and 30-52 h after the 50-mg dose. Elimination rates calculated from urine data corrected for creatinine concentration showed that morphine was eliminated more slowly than codeine. In plasma, the highest concentrations and area-under-curve values were observed for C6G, followed by codeine and M3G. All compounds had peak plasma values 1-2 h after dosing. The elimination of M3G was slower than that of C6G. We concluded that the relative proportion of codeine and morphine varies both between individuals and as a function of time and that morphine may be present in concentrations above those of codeine even after moderate and single doses of codeine. This must be taken into consideration when interpreting the presence of opiates during drugs-of-abuse testing.
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Affiliation(s)
- P Lafolie
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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31
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Hiltunen AJ, Lafolie P, Martel J, Ottosson EC, Boreus LO, Beck O, Borg S, Hjemdahl P. Subjective and objective symptoms in relation to plasma methadone concentration in methadone patients. Psychopharmacology (Berl) 1995; 118:122-6. [PMID: 7617797 DOI: 10.1007/bf02245829] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Two rating scales, which were originally developed for measurements of objective and subjective signs of opiate withdrawal, were used to evaluate potential estimates (correlates) of methadone effects in relation to plasma methadone concentrations. Patients participating in our regular methadone maintenance treatment project were studied during 24 h after the intake of the daily methadone dose. Methadone concentrations in plasma were compared to the subjective (estimated by the patients) and objective (estimated by the investigator) signs of the drug effects before, and 2.5, 5, 9 and 24 h after intake of methadone. Some new items possibly related to rising methadone concentrations were added to the subjective scale. Results indicated that, for subjective ratings, the majority of the items investigated corresponded well with the plasma methadone concentrations. The most significant associations were found for the following items: low psychomotor speed, alertness, running nose, yawning and anxiety. For objective ratings, only the items rhinorrhea, piloerection and signs of anxiety were significantly associated with the methadone concentrations. These rating scales may, together with plasma methadone determinations, be of considerable value when making dose adjustments for methadone maintenance patients. Further work is, however, needed to establish concentration-effect relationships.
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Affiliation(s)
- A J Hiltunen
- Department of Clinical Neuroscience, St Göran's Hospital, Karolinska Institute, Stockholm, Sweden
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32
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Abstract
Testing for drugs of abuse in urine is usually performed in two steps; after initial screening positive findings are confirmed with specific chromatographic techniques. The use of different methods with different cut-off levels, may lead to variable results in a test sample containing a drug. Sixty-eight Swedish laboratories were enrolled in an external quality study and received three control samples. The laboratories were instructed to perform only in-house tests for amphetamines, benzodiazepines, cannabinoids, cocaine and opiates. Nineteen out of the 68 laboratories reported fully correct results. Thirty reported one o more false positive drug findings. One laboratory performing confirmation with gas chromatography--mass spectrometry reported a false positive finding of amphetamines in the sample containing ephedrine. Since testing for drugs of abuse in urine is a delicate matter, with both medical and legal implications, such testing should be performed with a zero rate of false positive results. Routine use of specific methods for confirmation should be used since performance of these laboratories was better in this study. It is concluded that there is a need to continuously measure the level of quality of laboratories by a program for external quality control.
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Affiliation(s)
- P Lafolie
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
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33
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Abstract
Different analytical procedures for quantitation of total morphine and codeine in urine were evaluated. Hydrolysis of urine with hydrochloric acid and four different enzymes was compared. In order to effect complete hydrolysis of glucuronide conjugates, hydrolysis with 6.5M HCl containing bisulphite and heating at 100 degrees C for 20 min was required. Results using this hydrolysis procedure agreed well with results from direct analysis of free and conjugated forms by liquid chromatography. Use of more dilute HCl but at a higher temperature was not sufficient. Some enzymatic procedures appeared to give effective hydrolysis with a higher variability, but these procedures were more time-consuming. There was a good quantitative agreement between FID gas chromatography and ion-trap gas chromatography/mass spectrometry. The validated analytical procedure was applied to authentic patient samples.
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Affiliation(s)
- Z Lin
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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34
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Lafolie P, Beck O, Hjemdahl P, Borg S. Using relation between urinary cannabinoid and creatinine excretions to improve monitoring of abuser adherence to abstinence. Clin Chem 1994; 40:170-1. [PMID: 8287536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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35
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Lafolie P, Beck O, Hjemdahl P, Borg S. Using relation between urinary cannabinoid and creatinine excretions to improve monitoring of abuser adherence to abstinence. Clin Chem 1994. [DOI: 10.1093/clinchem/40.1.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Ericsson HR, Holmgren P, Jakobsson SW, Lafolie P, De Rees B. [Benzodiazepine findings in autopsy material. A study shows interacting factors in fatal cases]. Lakartidningen 1993; 90:3954-7. [PMID: 8231567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The paper consists in a report of a retrospective study (of data from 1987) on the prevalence of benzodiazepines in blood at the time of death. Of 2,007 autopsies, forensic chemical analyses were performed in 1,587 cases, in 159 of which benzodiazepines were found. Of these 159 deaths, 22 were considered to be due to natural causes, and in another 22 cases the cause of death was still unclear after examination; the remaining 115 deaths were due to accidents (N = 16), suicide (N = 60), drug addiction (N = 29) or alcoholism (N = 10). Multiple benzodiazepine intake was found in 37 cases, a subgroup including all 29 cases of death due to drug addiction. In a comparison of suicides and natural deaths, the concentrations both of flunitrazepam and nitrazepam were significantly higher among the suicides (P < 0.001 and P < 0.05, respectively). In four cases, the sole cause of death was benzodiazepine intake. It is concluded that some benzodiazepines, particularly flunitrazepam, may be more toxic than formerly supposed.
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Affiliation(s)
- H R Ericsson
- Rättsmedicinska institutionen, Karolinska institutet
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37
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38
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Beck O, Lafolie P, Hjemdahl P. Modification of commercial assay kits is justified. Clin Chem 1993; 39:1352-3. [PMID: 8504554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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39
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Beck O, Lafolie P, Hjemdahl P, Borg S, Odelius G, Wirbing P. Detection of benzodiazepine intake in therapeutic doses by immunoanalysis of urine: two techniques evaluated and modified for improved performance. Clin Chem 1992; 38:271-5. [PMID: 1541010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We evaluated the EMIT (enzyme-multiplied immuno technique) and FPIA (fluorescence polarization immunoassay) urine screening systems for detection of benzodiazepine intake. Healthy male volunteers were given single oral therapeutic doses of alprazolam (2 mg), chlordiazepoxide (25 mg), flunitrazepam (1 mg), lorazepam (3.75 mg), nitrazepam (5 mg), and triazolam (0.25 mg), after which urine was collected for the next 32 h. The EMIT method failed to detect the intake of flunitrazepam, lorazepam, and nitrazepam. FPIA did not detect the intake of chlordiazepoxide, flunitrazepam, lorazepam, nitrazepam, and triazolam. Modification of the EMIT method to include enzymatic hydrolysis did not significantly alter the results obtained with this method. A modification of the FPIA method to include enzymatic hydrolysis and a lower cutoff value improved the results considerably, so that we reliably detected all studied substances but flunitrazepam. We conclude that (a) both EMIT and FPIA techniques, when used as intended by the manufacturers, are unreliable for the detection of intake of therapeutic doses of these benzodiazepines, and (b) the described modification of the FPIA should provide a much improved tool for detection of benzodiazepine intake.
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Affiliation(s)
- O Beck
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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40
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Beck O, Lafolie P, Hjemdahl P, Borg S, Odelius G, Wirbing P. Detection of Benzodiazepine Intake in Therapeutic Doses by Immunoanalysis of Urine: Two Techniques Evaluated and Modified for Improved Performance. Clin Chem 1992. [DOI: 10.1093/clinchem/38.2.271] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We evaluated the EMIT (enzyme-multiplied immuno technique) and FPIA (fluorescence polarization immunoassay) urine screening systems for detection of benzodiazepine intake. Healthy male volunteers were given single oral therapeutic doses of alprazolam (2 mg), chlordiazepoxide (25 mg), flunitrazepam (1 mg), lorazepam (3.75 mg), nitrazepam (5 mg), and triazolam (0.25 mg), after which urine was collected for the next 32 h. The EMIT method failed to detect the intake of flunitrazepam, lorazepam, and nitrazepam. FPIA did not detect the intake of chlordiazepoxide, flunitrazepam, lorazepam, nitrazepam, and triazolam. Modification of the EMIT method to include enzymatic hydrolysis did not significantly alter the results obtained with this method. A modification of the FPIA method to include enzymatic hydrolysis and a lower cutoff value improved the results considerably, so that we reliably detected all studied substances but flunitrazepam. We conclude that (a) both EMIT and FPIA techniques, when used as intended by the manufacturers, are unreliable for the detection of intake of therapeutic doses of these benzodiazepines, and (b) the described modification of the FPIA should provide a much improved tool for detection of benzodiazepine intake.
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Affiliation(s)
- Olof Beck
- Department of Clinical Pharmacology, Karolinska Hospital, S-10401 , St. Görans Hospital, S-11281 Stockholm, Sweden
| | - Pierre Lafolie
- Department of Clinical Pharmacology, Karolinska Hospital, S-10401 , St. Görans Hospital, S-11281 Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Clinical Pharmacology, Karolinska Hospital, S-10401 , St. Görans Hospital, S-11281 Stockholm, Sweden
| | - Stefan Borg
- Department of Psychiatry, St. Görans Hospital, S-11281 Stockholm, Sweden
| | - Gudrun Odelius
- Department of Clinical Pharmacology, Karolinska Hospital, S-10401 , St. Görans Hospital, S-11281 Stockholm, Sweden
| | - Peter Wirbing
- Department of Clinical Pharmacology, Karolinska Hospital, S-10401 , St. Görans Hospital, S-11281 Stockholm, Sweden
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41
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Lafolie P, Beck O, Blennow G, Boréus L, Borg S, Elwin CE, Karlsson L, Odelius G, Hjemdahl P. Importance of creatinine analyses of urine when screening for abused drugs. Clin Chem 1991; 37:1927-31. [PMID: 1934467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report here a simple method involving urine creatine measurements for testing authenticity and reducing false-negative results in urine testing for drugs of abuse. Urinary creatinine in consecutive patient samples (n = 176) ranged between 0.1 and 31.9 mmol/L (mean 9.8 +/- SD 6.2) and the osmolality in these urines ranged between 49 and 1183 mOsm/kg (mean 595 +/- SD 276). With other consecutive samples in which creatinine was (arbitrarily chosen) less than 4.3 mmol/L (n = 85), the correlation with osmolality was lower. In 10 randomly selected urine samples from different patients, all "clean" for all drugs of abuse in initial immunological drug testing with approved methodology (in which creatinine was less than 4.3 mmol/L and osmolality was less than 200 mOsm/kg), five patients turned out to be drug positive after a simple concentration by volume. In a formerly heavy smoker of cannabis, the excretion of cannabinoids and creatinine was monitored for 93 days. The substances showed very good correlation throughout this period (r = 0.93, P less than 0.001), whereas simple measurements of cannabinoid concentrations would have falsely indicated several relapses of cannabis abuse. Urine samples used in drug-abuse testing should be tested for creatinine; if creatinine is less than 4.0 mmol/L, negative results for drugs may not be valid.
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Affiliation(s)
- P Lafolie
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
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42
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Lafolie P, Beck O, Blennow G, Boréus L, Borg S, Elwin CE, Karlsson L, Odelius G, Hjemdahl P. Importance of creatinine analyses of urine when screening for abused drugs. Clin Chem 1991. [DOI: 10.1093/clinchem/37.11.1927] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
We report here a simple method involving urine creatine measurements for testing authenticity and reducing false-negative results in urine testing for drugs of abuse. Urinary creatinine in consecutive patient samples (n = 176) ranged between 0.1 and 31.9 mmol/L (mean 9.8 +/- SD 6.2) and the osmolality in these urines ranged between 49 and 1183 mOsm/kg (mean 595 +/- SD 276). With other consecutive samples in which creatinine was (arbitrarily chosen) less than 4.3 mmol/L (n = 85), the correlation with osmolality was lower. In 10 randomly selected urine samples from different patients, all "clean" for all drugs of abuse in initial immunological drug testing with approved methodology (in which creatinine was less than 4.3 mmol/L and osmolality was less than 200 mOsm/kg), five patients turned out to be drug positive after a simple concentration by volume. In a formerly heavy smoker of cannabis, the excretion of cannabinoids and creatinine was monitored for 93 days. The substances showed very good correlation throughout this period (r = 0.93, P less than 0.001), whereas simple measurements of cannabinoid concentrations would have falsely indicated several relapses of cannabis abuse. Urine samples used in drug-abuse testing should be tested for creatinine; if creatinine is less than 4.0 mmol/L, negative results for drugs may not be valid.
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Affiliation(s)
- P Lafolie
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - O Beck
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - G Blennow
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - L Boréus
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - S Borg
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - C E Elwin
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - L Karlsson
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - G Odelius
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | - P Hjemdahl
- Department of Clinical Pharmacology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
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43
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Lafolie P, Beck O, Boréus L, Hjemdahl P, Borg S, Rydberg U. [Use and abuse of substance abuse analyses in urine]. Lakartidningen 1991; 88:3290-4. [PMID: 1943342] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Lafolie
- Samtliga vid avdelningen för klinisk farmakologi, Karolinska sjukhuset, Stockholm
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44
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Abstract
A method for the chiral high-performance liquid chromatographic analysis of methadone in plasma has been developed. The method employed organic solvent extraction, enantiomeric separation on a Chiral AGP column, and ultraviolet absorption detection at 212 nm. The intra-day variation in the quantification of methadone enantiomers was less than 9% at the 100 ng/ml level, and the values obtained correlated well with those from a gas chromatographic-mass spectrometric method. Results from patients indicate inter- and intra-individual differences in the ratio between l- and d-methadone in plasma during therapy with racemic methadone. In one patient, a higher level of d-methadone in plasma was caused by both faster elimination and lower bioavailability of l-methadone.
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Affiliation(s)
- O Beck
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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45
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Lafolie P, Hayder S, Björk O, Peterson C. Intraindividual variation in 6-mercaptopurine pharmacokinetics during oral maintenance therapy of children with acute lymphoblastic leukaemia. Eur J Clin Pharmacol 1991; 40:599-601. [PMID: 1884741 DOI: 10.1007/bf00279977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intraindividual variation in 6-mercaptopurine (6-MP) kinetics has been little studied. It has now been examined in 18 children with acute lymphoblastic leukaemia (ALL). On 2 to 4 occasions in each patient drug concentrations in plasma and red cells were followed for 4 h after administration by means of HPLC. The mean individual coefficient of variation (C.V.) in AUC was 57.9% and it was not related to dose or concentration. The variation was the same in plasma and in red cells. It is concluded that regular monitoring of 6-mercaptopurine concentration would identify periods when a patient deviates strongly from the mean range. Both undertreatment and concentration-dependent toxicity could then be corrected.
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Affiliation(s)
- P Lafolie
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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46
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Lafolie P. [Analyses in suspected abuse should be used carefully]. Lakartidningen 1991; 88:1570. [PMID: 2023507] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Lafolie
- Klinisk farmakologi, Karolinska sjukhuset
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47
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Beck O, Boreus LO, Borg S, Jacobsson G, Lafolie P, Stensiö M. Monitoring of plasma methadone: intercorrelation between immunoassay and gas chromatography-mass spectrometry. Ther Drug Monit 1990; 12:473-7. [PMID: 2293410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Determination of plasma methadone is essential in connection with dose adjustments for patients participating in methadone maintenance programs. We successfully adapted the existing fluorescence polarization immunoassay (FPIA) kit intended for urinary methadone to plasma assays. A concentration interval of 50-900 ng/ml could be covered. The coefficient of variation was less than 7%, and the limit of detection below 50 ng/ml. The intercorrelation between the immunoassay and a specific gas chromatographic-mass spectrometric (GC-MS) method was studied in samples from 19 heroin addicts in methadone maintenance treatment. A total number of 97 plasma samples with a concentration range of 31-842 ng/ml were used. The slope and intercept of the regression line (CFPIA = 0.93 X CGC-MS + 15) was in good agreement with the theoretical relation (CFPIA = CGC-MS), with a coefficient of correlation of 0.978. The mean ratio, in quantitative result, between the techniques (CFPIA/CGC-MS) was 1.03 +/- 0.01 (SEM). We conclude that the immunoassay proposed in this study can be safely used in patients participating in methadone maintenance programs.
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Affiliation(s)
- O Beck
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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48
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Hayder S, Björk O, Lafolie P. The course of biological parameters and 6-mercaptopurine pharmacokinetics during maintenance treatment of children with acute lymphoblastic leukaemia. Acta Paediatr Scand 1990; 79:832-7. [PMID: 2239280 DOI: 10.1111/j.1651-2227.1990.tb11562.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty patients on maintenance therapy (MT) for acute lymphoblastic leukaemia (ALL) with oral 6-mercaptopurine (6-MP) and methotrexate (MTX) were studied. White cell and red cell indices and platelets counts were monitored every second week as were drug levels. Mean values for 6-MP and MTX doses, and blood component parameters were calculated for each 6-month period for the whole patient group. 6-MP plasma concentrations and liver-function tests were determined once every six months and mean values calculated. 6-MP and MTX mean doses did not change significantly during MT. The mean area under the concentration versus time curve (AUC) 0-4 hours varied slightly from the start to the end of the MT (257 and 296 ng/ml.h, respectively). The mean plasma peak concentration increased from 98 ng/ml to 195 ng/ml (p less than 0.01) during the same period. There were significant decreases between the initial white blood cell counts (WBC) and red blood cell counts (RBC) as compared to levels at the end of therapy (p less than 0.01 and 0.02, respectively). A linear correlation was found between 6-MP peak concentrations and both WBC (r = 0.96) and RBC (r = 0.87). At the end of MT liver function tests became normal in all except 6 patients. In conclusion, MT have moderate effects on bone marrow and liver and monitoring 6-MP plasma concentration might be of value for determination of the optimal WBC levels during MT.
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Affiliation(s)
- S Hayder
- Department of Paediatrics, Karolinska Hospital, Stockholm, Sweden
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49
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Abstract
Immunological screening analysis of benzodiazepines in urine using the EMIT (enzyme multipled immuno-technique) and FPIA (fluorescence polarization immunoassay) techniques does not reliably detect the intake of therapeutic doses of oxazepam. In 23 patient urine samples, in which the presence of oxazepam could be verified chromatographically, only about 50% were detected as positive in the immunoassay systems. However, when the screening procedure was modified to include a simple step of hydrolysis of urine using the enzyme beta-glucuronidase to liberate conjugated oxazepam, improved detection of oxazepam intake was achieved. With EMIT 95% and with FPIA 100% of the samples were detected as positive. Since oxazepam arises in vivo also as a metabolite of other common benzodiazepines, the modification will most likely contribute to the generally improved detection of benzodiazepines.
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Affiliation(s)
- O Beck
- Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden
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Liliemark J, Pettersson B, Engberg B, Lafolie P, Masquelier M, Peterson C. On the paradoxically concentration-dependent metabolism of 6-mercaptopurine in WEHI-3b murine leukemia cells. Cancer Res 1990; 50:108-12. [PMID: 2293545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The intracellular metabolism of 6-mercaptopurine (6-MP) was studied in a murine leukemia cell line, WEHI-3b. Cells were incubated 3 to 24 h with 10 nM to 50 microM 6-MP. Nucleotides were extracted with perchloric acid, and the 6-thiopurine nucleotides were isolated on mercurial cellulose. The endogenous ribonucleotides in the perchloric acid extracts as well as 6-thiopurine nucleotides were separated and quantified with anion exchange high-performance liquid chromatography. The concentration of 6-thioinosinate (6-TIMP) and 6-thioxantinate (6-TXMP) increased with an increasing 6-MP dose. The concentration of the 6-thioguanosine nucleotides (6-TGN) increased with 6-MP concentrations between 10 nM and 1 microM. However, further increase in 6-MP concentration led to a decrease in the formation of 6-TGN. At 50 microM 6-MP, the concentration of 6-thioguanosine 5'-triphosphate was one fifth of that seen at 1 microM. The incorporation of 6-[35S]mercaptopurine into DNA was also slightly higher at 1 microM compared with 50 microM. The cytocidal effect on clonogenic cells was one log greater at 1 microM 6-MP compared with 50 microM 6-MP. The decrease of 6-TGN was accompanied not only by an increased 6-TIMP concentration but also by an inhibition of the purine de novo synthesis and consequently by a decrease of the cellular ATP concentration. The ATP concentration in the cells treated with 1 microM 6-MP could be reduced to the level seen in cells treated with 50 microM 6-MP by simultaneous incubation with 0.3 microM antimycin A. This decrease of ATP concentration was accompanied by a reduction of 6-TGN and to a lesser extent of 6-TXMP. These experiments suggest that the "self-limiting" phenomenon in the metabolism of 6-MP might be caused by a depletion of ATP by inhibition of purine de novo synthesis presumably by 6-TIMP.
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Affiliation(s)
- J Liliemark
- Department of Medicine, Karolinska Institute at Huddinge Hospital, Sweden
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