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Wang M, Wang T, Shan J, Sun Y. Alectinib induced vitiligo with rapid re-pigmentation. Eur J Cancer 2024; 200:113582. [PMID: 38306839 DOI: 10.1016/j.ejca.2024.113582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Meng Wang
- Hospital for Skin Diseases, Shandong First Medical University, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, China
| | - Tianyu Wang
- Hospital for Skin Diseases, Shandong First Medical University, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, China
| | - Jiao Shan
- Hospital for Skin Diseases, Shandong First Medical University, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, China
| | - Yonghu Sun
- Hospital for Skin Diseases, Shandong First Medical University, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, China.
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Bochtler T, Christopoulos P, Schlamp K, Winkler F, Krämer A. Management of a Pregnant ALK-Positive Lung Cancer Patient With Alectinib-Induced Pneumonitis and Bilateral Globus Pallidus Necrosis Postpartum. Clin Lung Cancer 2024; 25:72-76. [PMID: 37734987 DOI: 10.1016/j.cllc.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Tilmann Bochtler
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany; Department of Thoracic Oncology, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL).
| | - Petros Christopoulos
- Department of Thoracic Oncology, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL)
| | - Kai Schlamp
- Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL); Department of Thoracic Radiology, Heidelberg, Germany
| | - Frank Winkler
- Department of Neurooncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany; Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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van der Heijden LT, Steeghs N, Beijnen JH, Huitema ADR, Dorlo TPC. The use of microtracers in food-effect trials: An alternative study design for toxic drugs with long half-lives exemplified by the case for alectinib. Clin Transl Sci 2023; 16:2557-2564. [PMID: 37828717 PMCID: PMC10719472 DOI: 10.1111/cts.13647] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
The traditional design of food-effect studies has a high patient burden for toxic drugs with long half-lives (e.g., anticancer agents). Microtracers could be used to assess food-effect in patients without influencing their ongoing treatment. The feasibility of a microtracer food-effect study during steady-state of the therapeutic drug was investigated in an in silico simulation study with alectinib as an example for a relative toxic drug with a long half-life. Microtracer pharmacokinetics were simulated based on a previously published population pharmacokinetic model and used for estimation of a model with and a model without food as a covariate on oral bioavailability of alectinib (assuming a 40% food-effect). Power was defined as the fraction of clinical trials where a significant (p < 0.01) food-effect was identified. The proposed study design of 10 patients on steady-state treatment, 10 blood samples collected within 24 h after administration and an assumed food-effect of 40% had a power of 99.9%. The mean estimated food-effect was 39.8% (80% confidence interval: 31.0%-48.6%). The feasibility of microtracer food-effect studies was demonstrated. The design of the microtracer food-effect study allowed estimation of the food-effect with minimal influence on therapeutic treatment and reducing patient burden compared to the traditional study design for toxic drugs with long half-lives.
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Affiliation(s)
- L. T. van der Heijden
- Department of Pharmacy & PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division of PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - N. Steeghs
- Division of Medical Oncology, Department of Clinical PharmacologyAntoni van Leeuwenhoek Hospital/The Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - J. H. Beijnen
- Department of Pharmacy & PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division of PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division of Pharmaco‐epidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | - A. D. R. Huitema
- Department of Pharmacy & PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division of PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Pharmacy, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of PharmacologyPrincess Maxima CenterUtrechtThe Netherlands
| | - T. P. C. Dorlo
- Department of Pharmacy & PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division of PharmacologyAntoni van Leeuwenhoek/The Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of PharmacyUppsala UniversityUppsalaSweden
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de Leeuw SP, Pruis MA, Sikkema BJ, Mohseni M, Veerman GDM, Paats MS, Dumoulin DW, Smit EF, Schols AMWJ, Mathijssen RHJ, van Rossum EFC, Dingemans AMC. Analysis of Serious Weight Gain in Patients Using Alectinib for ALK-Positive Lung Cancer. J Thorac Oncol 2023; 18:1017-1030. [PMID: 37001858 DOI: 10.1016/j.jtho.2023.03.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Alectinib is a standard-of-care treatment for metastatic ALK+ NSCLC. Weight gain is an unexplored side effect reported in approximately 10%. To prevent or intervene alectinib-induced weight gain, more insight in its extent and etiology is needed. METHODS Change in body composition was analyzed in a prospective series of 46 patients with ALK+ NSCLC, treated with alectinib. Waist circumference, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle were quantified using sliceOmatic software on computed tomography images at baseline, 3 months (3M), and 1 year (1Y). To investigate an exposure-toxicity relationship, alectinib plasma concentrations were quantified. Four patients with more than 10 kg weight gain were referred to Erasmus MC Obesity Center CGG for in-depth analysis (e.g., assessments of appetite, dietary habits, other lifestyle, medical and psychosocial factors, and extensive metabolic and endocrine assessments, including resting energy expenditure). RESULTS Mean increase in waist circumference was 9 cm (9.7%, p < 0.001) in 1Y with a 40% increase in abdominal obesity (p = 0.014). VAT increased to 10.8 cm2 (15.0%, p = 0.003) in 3M and 35.7 cm2 (39.0%, p < 0.001) in 1Y. SAT increased to 18.8 cm2 (12.4%, p < 0.001) in 3M and 45.4 cm2 (33.3%, p < 0.001) in 1Y. The incidence of sarcopenic obesity increased from 23.7% to 47.4% during 1Y of treatment. Baseline waist circumference was a positive predictor of increase in VAT (p = 0.037). No exposure-toxicity relationship was found. In-depth analysis (n = 4) revealed increased appetite in two patients and metabolic syndrome in all four patients. CONCLUSIONS Alectinib may cause relevant increased sarcopenic abdominal obesity, with increases of both VAT and SAT, quickly after initiation. This may lead to many serious metabolic, physical, and mental disturbances in long-surviving patients.
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Affiliation(s)
- Simon P de Leeuw
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Melinda A Pruis
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Barend J Sikkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mostafa Mohseni
- Department of Internal Medicine, Division of Endocrinology and Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemie M W J Schols
- School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology and Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Zhou Y, Yin Y, Xu J, Xu Z, Yang B, He Q, Luo P, Yan H, Yang X. An update on Alectinib: a first line treatment for ALK-positive advanced lung cancer. Expert Opin Pharmacother 2023; 24:1361-1373. [PMID: 37278051 DOI: 10.1080/14656566.2023.2221786] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Alectinib is a second-generation, anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) for the treatment of ALK+ non-small cell lung cancer (NSCLC) and is able to induce significant and durable CNS responses. However, long-term use of alectinib has been clinically reported to cause some serious and even life-threatening adverse events. There are currently no effective interventions for its adverse events, and this undoubtedly leads to delays in patient treatment and limits its long-term clinical use. AREAS COVERED Based on the clinical trials conducted so far, we summarize the efficacy and adverse events that occurred, especially those related to cardiovascular disorders, gastrointestinal disorders, hepatobiliary disorders, musculoskeletal and connective tissue disorders, skin and subcutaneous tissue disorders, and respiratory disorders. The factors that may influence alectinib selection are also described. Findings are based on a PubMed literature search of clinical and basic science research papers spanning 1998-2023. EXPERT OPINION The significant prolongation of patient survival compared with first-generation ALK inhibitor suggests its potential as a first-line treatment for the NSCLC, but the severe adverse events of alectinib limit its long-term clinical use. Future research should focus on the exact mechanisms of these toxicities, how to alleviate the adverse events caused by alectinib clinically, and the development of next-generation drugs with reduced toxicities.
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Affiliation(s)
- Yourong Zhou
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yiming Yin
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jiangxin Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacy, Hangzhou Red Cross Hospital (Hangzhou Chest Hospital Affiliated to Zhejiang University Medical College), Hangzhou, China
| | - Zhifei Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovation Institute for Artificial Intelligence in Medicine, Zhejiang University, Hangzhou, China
| | - Peihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacology and Toxicology, Hangzhou Institute of Innovative Medicine, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Yan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaochun Yang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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Felip E, Smit EF, Molina-Vila MA, Dafni U, Massuti B, Berghmans T, de Marinis F, Passiglia F, Dingemans AMC, Cobo M, Viteri S, Britschgi C, Cuffe S, Provencio M, Merkelbach-Bruse S, Andriakopoulou C, Kammler R, Ruepp B, Roschitzki-Voser H, Peters S, Wolf J, Stahel R. Alectinib for the treatment of pretreated RET-rearranged advanced NSCLC: Results of the ETOP ALERT-lung trial. Lung Cancer 2022; 172:94-99. [PMID: 36030612 DOI: 10.1016/j.lungcan.2022.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/22/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alectinib, a highly selective next generation ALK-inhibitor, has exhibited potent anti-tumour activity in RET-rearranged NSCLC in the preclinical stage. METHODS ALERT-lung is a single-arm, phase II trial evaluating the activity of alectinib for the treatment of pretreated RET-rearranged advanced NSCLC. Alectinib was administered orally, 600 mg, twice per day until progression, refusal or unacceptable toxicity (treatment could continue beyond progression, if patient was deriving clinical benefit). Patient recruitment closed prematurely due to discouraging results for alectinib in a phase I/II study in the same indication. RESULTS All 14 patients who enrolled until the premature accrual closure, received at lease one dose of alectinib. Among them, median age was 61 years, majority (71 %) was female, never smokers, of ECOG PS 1. No objective response (complete or partial response) was recorded. Of the 13 evaluable patients, three (23 %) achieved and maintained disease stabilisation for 24 weeks. Up to 31 March 2021 (median follow-up 15.9 months), 12 PFS-events (92 %) were observed, with median PFS of 3.7 months (95 % C.I.: 1.8 - 7.3 months). Overall, three deaths (23 %) were reported. Seven patients (50 %) experienced grade ≥ 3 adverse events, while three discontinued treatment due to erythema multiforme of grade 3, related to alectinib. No treatment-related serious adverse event was reported. CONCLUSIONS Accrual into our trial was terminated early in response to other reports of limited activity of alectinib in patients with RET-fusion NSCLC and the emergence of more potent selective RET-inhibitors. Also in our trial, alectinib did not show the expected potential for anti-tumour activity in NSCLC.
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Affiliation(s)
- Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miguel A Molina-Vila
- Laboratory of Oncology, Pangaea Oncology, Dexeus University Hospital, Barcelona, Spain
| | - Urania Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation Hellas, Athens, Greece
| | - Bartomeu Massuti
- Medical Oncology Department, Hospital General Universitario Alicante, Alicante, Spain
| | | | - Filippo de Marinis
- Thoracic Oncology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Hospital, Orbassano, Turin, Italy
| | - Anne-Marie C Dingemans
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, the Netherlands & Department of Pulmonology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Manuel Cobo
- Unidad Gestion Intercentros of Medical Oncology. Regional and Virgen de la Victoria University Hospitals (IBIMA), Málaga, Spain
| | - Santiago Viteri
- Instituto Oncológico Dr Rosell, Hospital Universitario Dexeus. Grupo QuironSalud, Barcelona, Spain
| | - Christian Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Comprehensive Cancer Center Zurich, Zurich, Switzerland
| | - Sinead Cuffe
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - Mariano Provencio
- Hospital Puerta de Hierro, Majadahonda Medical Oncology Service, Madrid, Spain
| | - Sabine Merkelbach-Bruse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Pathology, Cologne, Germany
| | | | - Roswitha Kammler
- ETOP IBCSG Partners Foundation, Coordinating Center, Bern, Switzerland
| | - Barbara Ruepp
- ETOP IBCSG Partners Foundation, Coordinating Center, Bern, Switzerland
| | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jürgen Wolf
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Rolf Stahel
- ETOP IBCSG Partners Foundation, Coordinating Center, Bern, Switzerland.
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Zhang L, Yang YP. [Expert consensus on ensartinib in the treatment of anaplastic lymphoma kinase-positive non-small cell lung cancer]. Zhonghua Zhong Liu Za Zhi 2022; 44:297-307. [PMID: 35448917 DOI: 10.3760/cma.j.cn112152-20220113-00033] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The mutation rate of anaplastic lymphoma kinase (ALK) in patients with non-small cell lung cancer is 3% to 7%. Due to its low mutation rate and better long-term survival compared with epidermal growth factor receptor-positive non-small cell lung cancer patients, therefore, it's called "diamond mutation". At present, there are three generations of ALK tyrosine kinase inhibitor (TKI) drugs in the world. The first-generation ALK-TKI drug approved in China is crizotinib, and the second-generation drugs are alectinib, ceritinib and ensartinib. Among them, ensartinib is an ALK-TKI domestically developed, and its efficacy is similar to that of alectinib. The main adverse event is transient rash, and compliance to ensartinib is better from the perspective of long-term survival of patients. The manifestation of rash caused by ensartinib is different from that of other ALK-TKI drugs. In order to facilitate clinical application and provide patients with more treatment options, under the guidance of the Committee of Cancer Rehabilitation and Palliative Care of China Anti-Cancer Association, this article collects and summarizes the common adverse reactions of ensartinib. Based on the clinical practice, a clear adverse classification and specific treatment plan are formulated, in order to provide a corresponding reference for clinicians to make more comprehensive clinical decisions.
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Affiliation(s)
- L Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060
| | - Y P Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060
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Okumoto J, Sakamoto S, Masuda T, Yamaguchi K, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Fukushima N, Fujitaka K, Hamada H, Hattori N. Alectinib-induced Immune Hemolytic Anemia in a Patient with Lung Adenocarcinoma. Intern Med 2021; 60:611-615. [PMID: 32999219 PMCID: PMC7946499 DOI: 10.2169/internalmedicine.4241-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/16/2020] [Indexed: 11/06/2022] Open
Abstract
Drug-induced immune hemolytic anemia (DIIHA) is a rare condition with an increasing incidence associated with the frequent use of certain drugs. An 85-year-old woman with lung adenocarcinoma prescribed alectinib complained of dyspnea on exertion at our hospital. Based on her laboratory tests results on admission, we focused on the clinical course of anemia and hemolysis progression after alectinib administration. The patient's anemia and hemolysis gradually improved after discontinuation of alectinib, leading to a diagnosis of alectinib-induced IHA, presented here as the first case encountered in a patient with lung adenocarcinoma. Furthermore, we discuss the importance of correlating clinical laboratory findings in DIIHA.
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Affiliation(s)
- Joe Okumoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | | | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Hironobu Hamada
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
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Sacdalan DB, Lucero JA. Revisiting a lower starting dose of alectinib in ALK-Positive non-small cell lung cancer. Cancer Treat Res Commun 2021; 27:100319. [PMID: 33515938 DOI: 10.1016/j.ctarc.2021.100319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
We present here a case of ALK-positive lung adenocarcinoma that has been started on Alectinib. Treatment has been initiated at the recommended initial dose, but it subsequently required a dose adjustment following adverse drug events. Alectinib is a second-generation, CNS-active, tyrosine kinase inhibitor used in the treatment of ALK-positive non-small cell lung cancer. Its efficacy as a first-line treatment and as a second-line agent after Crizotinib has been proven across several trials both in terms of overall response rate and progression-free survival. The use of Alectinib is associated with side effects that occasionally lead to treatment discontinuation, interruption, or dose adjustment. Several studies have used two starting doses - 300 mg and 600 mg twice daily - across different populations and have consistently shown efficacy of Alectinib for both treatment doses. Results of these studies have also revealed that body weight, rather than race, affect the pharmacokinetics of Alectinib. Randomized trials have shown that the 600 mg dose is associated with more grade ≥3 adverse events and more changes in treatment in contrast to the 300 mg dose. A lower dose of Alectinib may limit treatment disruptions and dose reductions particularly for specific patient populations-particularly those with a lower body weight.
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Affiliation(s)
- Danielle Benedict Sacdalan
- Department of Pharmacology and Toxicology, University of the Philippines Manila College of Medicine, Taft Avenue, Manila, 1000 Philippines; Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000 Philippines.
| | - Josephine Anne Lucero
- Division of Hematology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000 Philippines
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López Pardo P, Sánchez Peña AM, Río Ramírez MT. Cryptogenic organizing pneumonia by alectinib. Med Clin (Barc) 2020; 157:91-92. [PMID: 33008605 DOI: 10.1016/j.medcli.2020.04.058] [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] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
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Uruha A, Kliesch S, Schmid S, Dittmayer C, Goebel HH, Dressel A, Stenzel W, Handreka R. Anaplastic lymphoma kinase inhibitor-associated myositis. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/4/e735. [PMID: 32376707 PMCID: PMC7217654 DOI: 10.1212/nxi.0000000000000735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Akinori Uruha
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Stefan Kliesch
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Simone Schmid
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Carsten Dittmayer
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Hans-Hilmar Goebel
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Alexander Dressel
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
| | - Werner Stenzel
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany.
| | - Robert Handreka
- From the Department of Neuropathology (A.U., S.S., C.D., H.-H.G., W.S.), Charité-Universitätsmedizin, Berlin; Department of Radiology (S.K.), Carl-Thiem-Klinikum Cottbus; Department of Neuropathology (H.-H.G.), Universitätsmedizin Mainz; Department of Neurology (A.D., R.H.), Carl-Thiem-Klinikum Cottbus; and Leibniz Science Campus Chronic Inflammation (W.S.), Berlin, Germany
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13
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Zude BP, Jampachaisri K, Pacharinsak C. Use of Flavored Tablets of Gabapentin and Carprofen to Attenuate Postoperative Hypersensitivity in an Incisional Pain Model in Rats ( Rattus norvegicus). J Am Assoc Lab Anim Sci 2020; 59:163-169. [PMID: 32075700 PMCID: PMC7073389 DOI: 10.30802/aalas-jaalas-19-000093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 09/24/2019] [Indexed: 01/07/2023]
Abstract
Providing postoperative analgesia to rats by oral administration, compared with injections, reduces stress from frequent handling and is technically easier for investigators. The purpose of this study was to investigate whether bacon-flavored tablets containing gabapentin, carprofen or a combination of both drugs effectively attenuates postoperative mechanical and thermal hypersensitivity in a rat model of incisional pain. Forty-eight Sprague-Dawley rats were randomly assigned to 1 of 5 treatment groups: placebo tablet; a single, subcutaneous injection of buprenorphine sustained release at 1.2 mg/kg; gabapentin 90 mg/tablet; carprofen 5 mg/tablet; gabapentin 90 mg and carprofen 5 mg/tablet (gabapentin/carprofen). Tablets were given to rats on days -3, -2, -1, 0 (surgery), 1, and 2. Rats were anesthetized using isoflurane. A 1 cm skin incision was made aseptically on the plantar surface of the left hindpaw and closed by using suture. Mechanical (von Frey monofilament) and thermal (Hargreaves method) hypersensitivity were tested daily, and analyzed on days -1, 1, 2, and 3. The amount of tablet consumed was recorded daily; postoperatively rats consumed 101 to 133 mg/kg of gabapentin, 5.5 to 5.8 mg/kg of carprofen, and 86-137/1.9-3 mg/kg of gabapentin/carprofen, respectively. Both the gabapentin and carprofen groups displayed attenuated mechanical hypersensitivity on all 3 postsurgical days and decreased thermal hypersensitivity on Day 3. The gabapentin/ carprofen group showed attenuated mechanical hypersensitivity on Day 2 and 3, but no significant reduction of thermal hypersensitivity. These data suggest that both gabapentin and carprofen, given orally by flavored tablet, effectively attenuate postoperative mechanical hypersensitivity for 3 d after surgery in a rat model of incisional pain.
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Affiliation(s)
- Brian P Zude
- Department of Comparative Medicine, Stanford University, Stanford, California;,
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14
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Bedas A, Peled N, Maimon Rabinovich N, Mishaeli M, Shochat T, Zer A, Rotem O, Allen AM, Bar J, Dudnik E. Efficacy and Safety of ALK Tyrosine Kinase Inhibitors in Elderly Patients with Advanced ALK-Positive Non-Small Cell Lung Cancer: Findings from the Real-Life Cohort. Oncol Res Treat 2019; 42:275-282. [PMID: 30955009 DOI: 10.1159/000499086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/05/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Aseel Bedas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Nir Peled
- Cancer Institute, Soroka University Medical Center, Beer-Sheva, Israel
- Ben Gurion University of Negev, Beer-Sheva, Israel
| | | | - Moshe Mishaeli
- Oncology Department, Meir Medical Center, Kfar Sava, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Alona Zer
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Ofer Rotem
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Aaron M Allen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Thoracic Oncology Unit, Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Elizabeth Dudnik
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel,
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15
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Li J, Yuan Z, Wang Q, Fan W, Zhang G. Meta-analysis of overall incidence and risk of ALK inhibitors-induced liver toxicities in advanced non-small-cell lung cancer. Medicine (Baltimore) 2019; 98:e13726. [PMID: 30608384 PMCID: PMC6344205 DOI: 10.1097/md.0000000000013726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM Activation of the anaplastic lymphoma kinase (ALK) gene has been found in several human cancers, including non-small-cell lung cancer (NSCLC). Currently, novel drugs targeting ALK gene have been extensively investigated in NSCLC. However, concerns about ALK inhibitors-induced liver toxicities have been increasing. MATERIALS AND METHODS Eligible prospective clinical studies have been searched in several databases. Primary outcomes of interest were incidence rates of liver toxicities, relative risks (RRs), and 95% confidence intervals (CIs). RESULTS Data from 2418 patients (1873 in the experimental arm; 545 in the control arm) were included. The incidences of all-grade alanine transaminase (ALT) and aspartate aminotransferase (AST) elevation were 26.0% (95% CI: 17.4%-37%), and 23.2% (95% CI, 16.7%-31.4%), respectively. The incidences of high-grade ALT and AST elevation were 8.4% (95% CI, 5.1%-13.4% and 7.0% (95% CI: 5.4%-9.0%), respectively. Sub-group analysis according to the ALK inhibitors found that pooled incidence of liver toxicities associated with ceritinib was higher than that of crizotinib and alectinib. In comparison with chemotherapy, ALK inhibitors significantly increased the all-grade and high-grade ALT elevation (RR 2.37, 95% CI, 1.97-2.86; P < .001; RR 7.34, 95% CI, 3.95-13.63; P < .001) and AST elevation (RR 3.27, 95% CI, 2.47-4.34; P < .001; RR 11.54, 95% CI, 4.33-30.7; P < .001), respectively. No publication bias was detected for RR of ALT and AST. CONCLUSIONS The findings of the present study offer substantial evidence that ALK inhibitors treatment in advanced NSCLC significantly increases the risk of developing all-grade and high-grade liver toxicities in comparison with controls. Clinicians should recognize liver toxicities promptly as early interventions may alleviate future complications.
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Yokoyama A, Tamura A, Miyakawa K, Kusaka K, Shimada M, Hirose T, Matsui H, Kitani M, Hebisawa A, Ohta K. Pulmonary Adenocarcinoma, Harboring Both an EGFR Mutation and ALK Rearrangement, Presenting a Stable Disease to Erlotinib and a Partial Response to Alectinib. Intern Med 2018; 57. [PMID: 29526950 PMCID: PMC6148164 DOI: 10.2169/internalmedicine.0383-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 63-year-old woman with pulmonary adenocarcinoma (stage IIIB) that was positive for an epidermal growth factor receptor (EGFR) mutation and an anaplastic lymphoma kinase (ALK) rearrangement was treated with erlotinib as the first-line treatment, resulting in a stable disease. Due to skin rashes, fatigue and anorexia, erlotinib was suspended on erlotinib day 44. Alectinib was administered as the second-line treatment, exhibiting a partial response. On alectinib day 56, drug-induced lung injury forced suspension of alectinib, which was cured with corticosteroid therapy. ALK-tyrosine kinase inhibitors may be more effective for patients positive for both EGFR mutation and ALK rearrangement than other agents.
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Affiliation(s)
- Akira Yokoyama
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
- Department of Respiratory Medicine, Graduated School of Medicine, The University of Tokyo, Japan
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Kazuko Miyakawa
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Kei Kusaka
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masahiro Shimada
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Takashi Hirose
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Akira Hebisawa
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
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Morcos PN, Nueesch E, Jaminion F, Guerini E, Hsu JC, Bordogna W, Balas B, Mercier F. Exposure-response analysis of alectinib in crizotinib-resistant ALK-positive non-small cell lung cancer. Cancer Chemother Pharmacol 2018; 82:129-138. [PMID: 29748847 PMCID: PMC6010493 DOI: 10.1007/s00280-018-3597-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/01/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Alectinib is a selective and potent anaplastic lymphoma kinase (ALK) inhibitor that is active in the central nervous system (CNS). Alectinib demonstrated robust efficacy in a pooled analysis of two single-arm, open-label phase II studies (NP28673, NCT01801111; NP28761, NCT01871805) in crizotinib-resistant ALK-positive non-small-cell lung cancer (NSCLC): median overall survival (OS) 29.1 months (95% confidence interval [CI]: 21.3-39.0) for alectinib 600 mg twice daily (BID). We investigated exposure-response relationships from final pooled phase II OS and safety data to assess alectinib dose selection. METHODS A semi-parametric Cox proportional hazards model analyzed relationships between individual median observed steady-state trough concentrations (Ctrough,ss) for combined exposure of alectinib and its major metabolite (M4), baseline covariates (demographics and disease characteristics) and OS. Univariate logistic regression analysis analyzed relationships between Ctrough,ss and incidence of adverse events (AEs: serious and Grade ≥ 3). RESULTS Overall, 92% of patients (n = 207/225) had Ctrough,ss data and were included in the analysis. No statistically significant relationship was found between Ctrough,ss and OS following alectinib treatment. The only baseline covariates that statistically influenced OS were baseline tumor size and prior crizotinib treatment duration. Larger baseline tumor size and shorter prior crizotinib treatment were both associated with shorter OS. Logistic regression confirmed no significant relationship between Ctrough,ss and AEs. CONCLUSION Alectinib 600 mg BID provides systemic exposures at plateau of response for OS while maintaining a well-tolerated safety profile. This analysis confirms alectinib 600 mg BID as the recommended global dose for patients with crizotinib-resistant ALK-positive NSCLC.
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Affiliation(s)
| | | | | | | | - Joy C Hsu
- Roche Innovation Center New York, New York, NY, USA
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Affiliation(s)
- Arjun Gupta
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R Das
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Peters S, Camidge DR, Shaw AT, Gadgeel S, Ahn JS, Kim DW, Ou SHI, Pérol M, Dziadziuszko R, Rosell R, Zeaiter A, Mitry E, Golding S, Balas B, Noe J, Morcos PN, Mok T. Alectinib versus Crizotinib in Untreated ALK-Positive Non-Small-Cell Lung Cancer. N Engl J Med 2017; 377:829-838. [PMID: 28586279 DOI: 10.1056/nejmoa1704795] [Citation(s) in RCA: 1509] [Impact Index Per Article: 215.6] [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: 12/21/2022]
Abstract
BACKGROUND Alectinib, a highly selective inhibitor of anaplastic lymphoma kinase (ALK), has shown systemic and central nervous system (CNS) efficacy in the treatment of ALK-positive non-small-cell lung cancer (NSCLC). We investigated alectinib as compared with crizotinib in patients with previously untreated, advanced ALK-positive NSCLC, including those with asymptomatic CNS disease. METHODS In a randomized, open-label, phase 3 trial, we randomly assigned 303 patients with previously untreated, advanced ALK-positive NSCLC to receive either alectinib (600 mg twice daily) or crizotinib (250 mg twice daily). The primary end point was investigator-assessed progression-free survival. Secondary end points were independent review committee-assessed progression-free survival, time to CNS progression, objective response rate, and overall survival. RESULTS During a median follow-up of 17.6 months (crizotinib) and 18.6 months (alectinib), an event of disease progression or death occurred in 62 of 152 patients (41%) in the alectinib group and 102 of 151 patients (68%) in the crizotinib group. The rate of investigator-assessed progression-free survival was significantly higher with alectinib than with crizotinib (12-month event-free survival rate, 68.4% [95% confidence interval (CI), 61.0 to 75.9] with alectinib vs. 48.7% [95% CI, 40.4 to 56.9] with crizotinib; hazard ratio for disease progression or death, 0.47 [95% CI, 0.34 to 0.65]; P<0.001); the median progression-free survival with alectinib was not reached. The results for independent review committee-assessed progression-free survival were consistent with those for the primary end point. A total of 18 patients (12%) in the alectinib group had an event of CNS progression, as compared with 68 patients (45%) in the crizotinib group (cause-specific hazard ratio, 0.16; 95% CI, 0.10 to 0.28; P<0.001). A response occurred in 126 patients in the alectinib group (response rate, 82.9%; 95% CI, 76.0 to 88.5) and in 114 patients in the crizotinib group (response rate, 75.5%; 95% CI, 67.8 to 82.1) (P=0.09). Grade 3 to 5 adverse events were less frequent with alectinib (41% vs. 50% with crizotinib). CONCLUSIONS As compared with crizotinib, alectinib showed superior efficacy and lower toxicity in primary treatment of ALK-positive NSCLC. (Funded by F. Hoffmann-La Roche; ALEX ClinicalTrials.gov number, NCT02075840 .).
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Affiliation(s)
- Solange Peters
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - D Ross Camidge
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Alice T Shaw
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Shirish Gadgeel
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Jin S Ahn
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Dong-Wan Kim
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Sai-Hong I Ou
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Maurice Pérol
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Rafal Dziadziuszko
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Rafael Rosell
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Ali Zeaiter
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Emmanuel Mitry
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Sophie Golding
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Bogdana Balas
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Johannes Noe
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Peter N Morcos
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
| | - Tony Mok
- From Lausanne University Hospital, Lausanne (S.P.), and F. Hoffmann-La Roche, Basel (A.Z., E.M., S. Golding, B.B., J.N.) - both in Switzerland; University of Colorado, Denver (D.R.C.); Massachusetts General Hospital, Boston (A.T.S.); University of Michigan, Ann Arbor (S. Gadgeel); Samsung Medical Center, Sungkyunkwan University School of Medicine (J.S.A.), and Seoul National University Hospital (D.-W.K.) - both in Seoul, South Korea; Chao Family Comprehensive Cancer Center, University of California, Irvine, School of Medicine, Orange (S.-H.I.O.); Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France (M.P.); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland (R.D.); Catalan Institute of Oncology, Barcelona (R.R.); Roche Innovation Center, New York (P.N.M.); and State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong (T.M.)
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20
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Hida T, Nokihara H, Kondo M, Kim YH, Azuma K, Seto T, Takiguchi Y, Nishio M, Yoshioka H, Imamura F, Hotta K, Watanabe S, Goto K, Satouchi M, Kozuki T, Shukuya T, Nakagawa K, Mitsudomi T, Yamamoto N, Asakawa T, Asabe R, Tanaka T, Tamura T. Alectinib versus crizotinib in patients with ALK-positive non-small-cell lung cancer (J-ALEX): an open-label, randomised phase 3 trial. Lancet 2017; 390:29-39. [PMID: 28501140 DOI: 10.1016/s0140-6736(17)30565-2] [Citation(s) in RCA: 621] [Impact Index Per Article: 88.7] [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] [Received: 11/17/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alectinib, a potent, highly selective, CNS-active inhibitor of anaplastic lymphoma kinase (ALK), showed promising efficacy and tolerability in the single-arm phase 1/2 AF-001JP trial in Japanese patients with ALK-positive non-small-cell lung cancer. Given those promising results, we did a phase 3 trial to directly compare the efficacy and safety of alectinib and crizotinib. METHODS J-ALEX was a randomised, open-label, phase 3 trial that recruited ALK inhibitor-naive Japanese patients with ALK-positive non-small-cell lung cancer, who were chemotherapy-naive or had received one previous chemotherapy regimen, from 41 study sites in Japan. Patients were randomly assigned (1:1) via an interactive web response system using a permuted-block method stratified by Eastern Cooperative Oncology Group performance status, treatment line, and disease stage to receive oral alectinib 300 mg twice daily or crizotinib 250 mg twice daily until progressive disease, unacceptable toxicity, death, or withdrawal. The primary endpoint was progression-free survival assessed by an independent review facility. The efficacy analysis was done in the intention-to-treat population, and safety analyses were done in all patients who received at least one dose of the study drug. The study is ongoing and patient recruitment is closed. This study is registered with the Japan Pharmaceutical Information Center (number JapicCTI-132316). FINDINGS Between Nov 18, 2013, and Aug 4, 2015, 207 patients were recruited and assigned to the alectinib (n=103) or crizotinib (n=104) groups. At data cutoff for the second interim analysis, 24 patients in the alectinib group had discontinued treatment compared with 61 in the crizotinib group, mostly due to lack of efficacy or adverse events. At the second interim analysis (data cutoff date Dec 3, 2015), an independent data monitoring committee determined that the primary endpoint of the study had been met (hazard ratio 0·34 [99·7% CI 0·17-0·71], stratified log-rank p<0·0001) and recommended an immediate release of the data. Median progression-free survival had not yet been reached with alectinib (95% CI 20·3-not estimated) and was 10·2 months (8·2-12·0) with crizotinib. Grade 3 or 4 adverse events occurred at a greater frequency with crizotinib (54 [52%] of 104) than alectinib (27 [26%] of 103). Dose interruptions due to adverse events were also more prevalent with crizotinib (77 [74%] of 104) than with alectinib (30 [29%] of 103), and more patients receiving crizotinib (21 [20%]) than alectinib (nine [9%]) discontinued the study drug because of an adverse event. No adverse events with a fatal outcome occurred in either treatment group. INTERPRETATION These results provide the first head-to-head comparison of alectinib and crizotinib and have the potential to change the standard of care for the first-line treatment of ALK-positive non-small-cell lung cancer. The dose of alectinib (300 mg twice daily) used in this study is lower than the approved dose in countries other than Japan; however, this limitation is being addressed in the ongoing ALEX study. FUNDING Chugai Pharmaceutical Co, Ltd.
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Affiliation(s)
- Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hiroshi Nokihara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Azuma
- Institution Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Katsuyuki Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, Shikoku Cancer Center, Matsuyama, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Asakawa
- Clinical Science and Strategy Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Ryoichi Asabe
- Clinical Study Management Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Tomohiro Tanaka
- Clinical Science and Strategy Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
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21
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Zhu Q, Hu H, Weng DS, Zhang XF, Chen CL, Zhou ZQ, Tang Y, Xia JC. Pooled safety analyses of ALK-TKI inhibitor in ALK-positive NSCLC. BMC Cancer 2017; 17:412. [PMID: 28606126 PMCID: PMC5469041 DOI: 10.1186/s12885-017-3405-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) have been administered to patients with ALK-positive non-small cell lung cancer for a long period of time and show a promising response. However, the differences in the toxicity profiles among these drugs are still unclear. METHODS We performed a comprehensive search of the MEDLINE, EMBASE, WEB OF SCIENCE and COCHRANE databases from the drugs' inception to May 2016 to identify clinical trials. Severe adverse events (AEs) (grade ≥ 3) based on the ALK-TKI type were analysed. RESULTS Seventeen trials published between 2011 and 2016, including a total of 1826 patients, were eligible for analysis. Patients in 10 trials (n = 1000) received crizotinib, patients in 5 trials (n = 601) received ceritinib and patients in 2 trials (n = 225) received alectinib. The overall frequencies of treatment-related death and AEs due to treatment withdrawal were 0.9% (12/1365) and 5.5% (85/1543), respectively. Moreover, the frequency of severe AEs in patients treated with ceritinib was significantly higher than patients treated with crizotinib or alectinib, especially for hepatotoxicity, fatigue and some of gastrointestinal symptoms. Additionally, significant difference in the elevated lipase and amylase levels (grade ≥ 3) were detected between ceritinib and crizotinib/alectinib, whereas neutropenia was less frequent. CONCLUSIONS ALK-TKIs were safe for ALK-positive patients. Moreover, statistically significant differences in some severe AEs among ceritinib, crizotinib and alectinib were detected in present study.
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Affiliation(s)
- Qian Zhu
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Hao Hu
- Department of Thoracic Surgery, Medical College of Nanchang University, Nanchang, 330006 People’s Republic of China
| | - De-Sheng Weng
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Xiao-Fei Zhang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Chang-Long Chen
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Zi-Qi Zhou
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Yan Tang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Jian-Chuan Xia
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
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22
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Tsetskhladze E, Khintibidze I. THE SAFETY AND EFFICACY OF AMIODARONE AND CARVEDILOL COMBINATION IN TREATMENT OF PATIENTS WITH SEVERE CARDIAC RHYTHM DISORDERS. Georgian Med News 2017:53-57. [PMID: 28726654] [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: 06/07/2023]
Abstract
Different arrhythmias are cause of sudden death in many patients with heart failure. Amiodarone is usually used for prevent this arrhythmias, but it is not drug of choice for treatment the patients with heart failure. We retrospectively analyzed 142 patients with moderate and severe heart failure and history of myocardial infarction. These patients have received amiodarone, carvedilol or combination of these two medications together with standard therapy. In our retrospective analysis, the combination therapy with Amiodarone and Carvedilol had highly significant decrease arrhythmic death compare with carvedilol and amiodarone groups. This therapy is more effective in recovering of sinus rhythm in patients with atrial fibrillation and for control ventricular arrhythmias. The effects of carvedilol on left ventricular remodeling, systolic function and symptomatic status are not affected adversly by concurrent treatment with amiodarone. Carvedilol is an effective additional therapy for the patients with chronic heart failure already receiving Amiodarone. Carvedilol can be added to Amiodarone in patients with severe ventricular rhythm disorders and increased risk of sudden death without expecting of increase adverse events (than either drug alone) or loss of clinical efficacy.
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23
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Armenian SH, Hudson MM, Chen MH, Colan SD, Lindenfeld L, Mills G, Siyahian A, Gelehrter S, Dang H, Hein W, Green DM, Robison LL, Wong FL, Douglas PS, Bhatia S. Rationale and design of the Children's Oncology Group (COG) study ALTE1621: a randomized, placebo-controlled trial to determine if low-dose carvedilol can prevent anthracycline-related left ventricular remodeling in childhood cancer survivors at high risk for developing heart failure. BMC Cardiovasc Disord 2016; 16:187. [PMID: 27716152 PMCID: PMC5050602 DOI: 10.1186/s12872-016-0364-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anthracyclines are widely used in the treatment of childhood cancer. One of the well-recognized side-effects of anthracycline therapy is dose-dependent cardiomyopathy that may progress to heart failure (HF) years after completion of cancer-directed therapy. This study will evaluate the efficacy of low-dose beta-blocker (carvedilol) for HF risk reduction in childhood cancer survivors at highest risk for HF. The proposed intervention has the potential to significantly reduce chronic cardiac injury via interruption of neurohormonal systems responsible for left ventricular (LV) remodeling, resulting in improved cardiac function and decreased risk of HF. The intervention is informed by previous studies demonstrating efficacy in pediatric and adult non-oncology populations, yet remains unstudied in the pediatric oncology population. METHODS/DESIGN The primary objective of the trial is to determine impact of the intervention on echocardiographic markers of cardiac remodeling and HF risk, including: LV wall thickness/ dimension ratio (LVWT/D; primary endpoint), as well as LV ejection fraction, volume, and blood biomarkers (natriuretic peptides, galectin-3) associated with HF risk. Secondary objectives are to establish safety and tolerability of the 2-year course of carvedilol using: 1) objective measures: hepatic and cardiovascular toxicity, treatment adherence, and 2) subjective measures: participant self-reported outcomes. Two hundred and fifty survivors of childhood cancer (diagnosed <21 years of age), and previously treated with high-dose (≥300 mg/m2) anthracyclines will be enrolled in a randomized, double-blind, placebo controlled trial. After baseline assessments, participants will be randomized in a 1:1 ratio to low-dose carvedilol (maximum dose: 12.5 mg/day) or placebo. Carvedilol or placebo is up-titrated (starting dose: 3.125 mg/day) according to tolerability. DISCUSSION When completed, this study will provide much-needed information regarding a physiologically plausible pharmacological risk-reduction strategy for childhood cancer survivors at high risk for developing anthracycline-related HF. TRIAL REGISTRATION ClinicalTrials.gov; NCT02717507.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Adrenergic beta-Antagonists/adverse effects
- Age Factors
- Anthracyclines/adverse effects
- Antibiotics, Antineoplastic/adverse effects
- Carbazoles/administration & dosage
- Carbazoles/adverse effects
- Cardiotoxicity
- Carvedilol
- Clinical Protocols
- Double-Blind Method
- Female
- Heart Failure/chemically induced
- Heart Failure/diagnosis
- Heart Failure/physiopathology
- Heart Failure/prevention & control
- Humans
- Hypertrophy, Left Ventricular/chemically induced
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/prevention & control
- Male
- Propanolamines/administration & dosage
- Propanolamines/adverse effects
- Research Design
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/prevention & control
- Ventricular Function, Left/drug effects
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Saro H. Armenian
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Ming Hui Chen
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Lanie Lindenfeld
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - George Mills
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Aida Siyahian
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Sarah Gelehrter
- Pediatric Cardiology, C.S. Mott Children’s Hospital, Ann Arbor, MI USA
| | - Ha Dang
- Children’s Oncology Group, Arcadia, CA USA
| | - Wendy Hein
- Survive & Thrive Long-term Follow-up Program, Children’s Mercy Hospital, Kansas City, USA
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL USA
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24
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Franken PR, Woltersdorf R. [Risk of renal dysfunction in an elderly patient with chronic heart failure]. Med Monatsschr Pharm 2016; 39:421-426. [PMID: 29979537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The treatment of elderly multimorbid patients according to clinical guidelines often results in polypharmacy. An individual risk assessment is required to consider the possibility of deprescribing especially potentially inappropriate medication in the elderly. This exemplary case report describes a medication review of a patient with multiple chronic cardiovascular diseases taking into account the impact on renal function.
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25
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Knight JM, Mak G, Shaw J, Porter P, McDermott C, Roberts L, You R, Yuan X, Millien VO, Qian Y, Song LZ, Frazier V, Kim C, Kim JJ, Bond RA, Milner JD, Zhang Y, Mandal PK, Luong A, Kheradmand F, McMurray JS, Corry DB. Long-Acting Beta Agonists Enhance Allergic Airway Disease. PLoS One 2015; 10:e0142212. [PMID: 26605551 PMCID: PMC4659681 DOI: 10.1371/journal.pone.0142212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/19/2015] [Indexed: 01/11/2023] Open
Abstract
Asthma is one of the most common of medical illnesses and is treated in part by drugs that activate the beta-2-adrenoceptor (β2-AR) to dilate obstructed airways. Such drugs include long acting beta agonists (LABAs) that are paradoxically linked to excess asthma-related mortality. Here we show that LABAs such as salmeterol and structurally related β2-AR drugs such as formoterol and carvedilol, but not short-acting agonists (SABAs) such as albuterol, promote exaggerated asthma-like allergic airway disease and enhanced airway constriction in mice. We demonstrate that salmeterol aberrantly promotes activation of the allergic disease-related transcription factor signal transducer and activator of transcription 6 (STAT6) in multiple mouse and human cells. A novel inhibitor of STAT6, PM-242H, inhibited initiation of allergic disease induced by airway fungal challenge, reversed established allergic airway disease in mice, and blocked salmeterol-dependent enhanced allergic airway disease. Thus, structurally related β2-AR ligands aberrantly activate STAT6 and promote allergic airway disease. This untoward pharmacological property likely explains adverse outcomes observed with LABAs, which may be overcome by agents that antagonize STAT6.
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MESH Headings
- Adrenergic beta-2 Receptor Agonists/adverse effects
- Albuterol/therapeutic use
- Animals
- Anti-Asthmatic Agents/adverse effects
- Arrestins/deficiency
- Arrestins/genetics
- Aspergillosis, Allergic Bronchopulmonary/drug therapy
- Aspergillosis, Allergic Bronchopulmonary/genetics
- Aspergillosis, Allergic Bronchopulmonary/metabolism
- Aspergillosis, Allergic Bronchopulmonary/pathology
- Aspergillus niger/physiology
- Asthma/chemically induced
- Asthma/drug therapy
- Asthma/genetics
- Asthma/metabolism
- Bronchoconstriction/drug effects
- Carbazoles/adverse effects
- Carvedilol
- Disease Models, Animal
- Female
- Formoterol Fumarate/adverse effects
- Gene Expression
- Humans
- Lung/drug effects
- Lung/metabolism
- Lung/pathology
- Mice
- Mice, Knockout
- Peptidomimetics/pharmacology
- Propanolamines/adverse effects
- Receptors, Adrenergic, beta-2/deficiency
- Receptors, Adrenergic, beta-2/genetics
- STAT6 Transcription Factor/agonists
- STAT6 Transcription Factor/antagonists & inhibitors
- STAT6 Transcription Factor/genetics
- STAT6 Transcription Factor/metabolism
- Salmeterol Xinafoate/adverse effects
- beta-Arrestins
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Affiliation(s)
- John M Knight
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Garbo Mak
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Joanne Shaw
- Department of Otorhinolaryngolgy - Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Paul Porter
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Catherine McDermott
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Luz Roberts
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Ran You
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Xiaoyi Yuan
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Valentine O Millien
- Department of Medicine and the Translational Biology and Molecular Medicine Program, Baylor College of Medicine, Houston, Texas, United States of America
| | - Yuping Qian
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Li-Zhen Song
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Vincent Frazier
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Choel Kim
- Departments of Pharmacology, and Biochemistry & Molecular Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeong Joo Kim
- Department of Biochemistry & Molecular Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Richard A Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston College of Pharmacy, Houston, Texas, United States of America
| | - Joshua D Milner
- Laboratory of Allergic Diseases, National Institutes of Allergic and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Yuan Zhang
- Laboratory of Allergic Diseases, National Institutes of Allergic and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pijus K Mandal
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Amber Luong
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center and the Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Farrah Kheradmand
- Departments of Medicine and Pathology & Immunology, Translational Biology and Molecular Medicine Program, and the Biology of Inflammation Center, Baylor College of Medicine and the Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States of America
| | - John S McMurray
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - David B Corry
- Departments of Medicine and Pathology & Immunology, Translational Biology and Molecular Medicine Program, and the Biology of Inflammation Center, Baylor College of Medicine and the Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States of America
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26
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Fourie T, Cromarty D, Duncan N, Wolter K, Naidoo V. The Safety and Pharmacokinetics of Carprofen, Flunixin and Phenylbutazone in the Cape Vulture (Gyps coprotheres) following Oral Exposure. PLoS One 2015; 10:e0141419. [PMID: 26512724 PMCID: PMC4626400 DOI: 10.1371/journal.pone.0141419] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/08/2015] [Indexed: 11/19/2022] Open
Abstract
The following study evaluates the overt toxic potential of carprofen (CRP), flunixin (FXN) and phenylbutazone (PBZ) in Old world vultures in relation to historic toxicity data for diclofenac and ketoprofen, with the Cape vulture (Gyps coprotheres) being the indicator species. The toxic potential of a single oral dose of CRP (11.5 mg/kg), FXN (1 mg/kg),PBZ (1.7 mg/kg) or water was evaluated by means of a four-way parallel study (n = 2), as means of ascertaining if these drugs were as toxic as diclofenac in the vulture. No unscheduled deaths or pathological lesions were noted following exposure. Clinical signs of lethargy and depression were, however, noted in one CRP, two FXN and one PBZ treated birds. Mild reversible inhibition of UA excretion was evident in all three groups, although UA remained within the population reference interval in contrast to the effects previously described for diclofenac and ketoprofen. All treatment groups had a drug concentration responsive increase in alanine transferase activity. CRP, FXN and PBZ were characterised by a maximum plasma concentration (Cmax) of 1051.8 ± 620.7 ng/ml, 335.9 ± 36.3 ng/ml and 11150 ± 2474.9 ng/ml at 4 ± 4.3, 0.45 ± 0.02 and 5.3 ± 5.2 hours (Tmax) respectively and a half-life of elimination of 13.3 ±5, 1.8±1 and 18.7 ±11.4 hours respectively. While we could not demonstrate a lethal effect of the tested substances, the presence of toxic clinical signs, clinical pathological changes and/or long half-lives of elimination suggests that all three drugs have a potential for toxicity in a larger population or on repeat administration. In conclusion while the studied substances were not as overtly toxic as diclofenac, they are of safety concern.
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Affiliation(s)
- Tamsyn Fourie
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Duncan Cromarty
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Neil Duncan
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Kerri Wolter
- Vulture Programme (VulPro), Plot 121, Rietfontein, 0048, South Africa
| | - Vinny Naidoo
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
- * E-mail:
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27
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Møller-Helgestad OK, Kaltoft AK, Kasch H. [Frovatriptan possibly causing acute myocardial infarction]. Ugeskr Laeger 2015; 177:V10140537. [PMID: 25822816] [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: 06/04/2023]
Abstract
Globally migraine affects more than 10% of the adult population and it is treated with simple analgesics, combined with a triptan for a stronger treatment effect. Triptans cause arterial vasoconstriction, and this is a case report of vasospasm-induced acute myocardial infarction in a 61-year-old woman with frequent episodic migraine attacks treated with triptans. She was possibly also suffering from medication overuse headache. We suggest that regular frovatriptan use may have contributed to the myocardial infarction and that long-term triptan use may have caused the medication overuse headache.
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28
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Süssmuth SD, Haider S, Landwehrmeyer GB, Farmer R, Frost C, Tripepi G, Andersen CA, Di Bacco M, Lamanna C, Diodato E, Massai L, Diamanti D, Mori E, Magnoni L, Dreyhaupt J, Schiefele K, Craufurd D, Saft C, Rudzinska M, Ryglewicz D, Orth M, Brzozy S, Baran A, Pollio G, Andre R, Tabrizi SJ, Darpo B, Westerberg G. An exploratory double-blind, randomized clinical trial with selisistat, a SirT1 inhibitor, in patients with Huntington's disease. Br J Clin Pharmacol 2015; 79:465-76. [PMID: 25223731 PMCID: PMC4345957 DOI: 10.1111/bcp.12512] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/06/2014] [Indexed: 12/22/2022] Open
Abstract
AIMS Selisistat, a selective SirT1 inhibitor is being developed as a potentially disease-modifying therapeutic for Huntington's disease (HD). This was the first study of selisistat in HD patients and was primarily aimed at development of pharmacodynamic biomarkers. METHODS This was a randomized, double-blind, placebo-controlled, multicentre exploratory study. Fifty-five male and female patients in early stage HD were randomized to receive 10 mg or 100 mg of selisistat or placebo once daily for 14 days. Blood sampling, clinical and safety assessments were conducted throughout the study. Candidate pharmacodynamic markers included circulating soluble huntingtin and innate immune markers. RESULTS Selisistat was found to be safe and well tolerated, and systemic exposure parameters showed that the average steady-state plasma concentration achieved at the 10 mg dose level (125 nm) was comparable with the IC50 for SirT1 inhibition. No adverse effects on motor, cognitive or functional readouts were recorded. While circulating levels of soluble huntingtin were not affected by selisistat in this study, the biological samples collected have allowed development of assay technology for use in future studies. No effects on innate immune markers were seen. CONCLUSIONS Selisistat was found to be safe and well tolerated in early stage HD patients at plasma concentrations within the anticipated therapeutic concentration range.
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Affiliation(s)
| | - Salman Haider
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | | | - Ruth Farmer
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | | | | | | | - Claudia Lamanna
- Siena Biotech SpASiena, Italy
- European Huntington's Disease Network (EHDN)Chieti, Italy
| | | | | | | | | | | | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
| | - Karin Schiefele
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
| | - David Craufurd
- Institute of Human Development, Faculty of Medical and Human Sciences, University of ManchesterManchester, United Kingdom
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science CentreManchester, United Kingdom
| | - Carsten Saft
- Department of Neurology, Huntington-Center NRW, St. Josef-Hospital, Ruhr-UniversityBochum, Germany
| | - Monika Rudzinska
- Department of Neurology, Medical University of SilesiaKatowice, Poland
| | - Danuta Ryglewicz
- Department of Neurology, Institute of Psychiatry and NeurologyWarsaw, Poland
| | - Michael Orth
- Department of Neurology, Ulm University HospitalUlm, Germany
| | | | | | | | - Ralph Andre
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | - Borje Darpo
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd HospitalStockholm, Sweden
- iCardiac TechnologiesRochester, NY, USA
| | - Goran Westerberg
- Siena Biotech SpASiena, Italy
- La Crocina Pharmaceutical Consultants D.I.San Giovanni d'Asso (S), Italy
| | - Paddington Consortium
- Department of Neurology, Ulm University HospitalUlm, Germany
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
- Siena Biotech SpASiena, Italy
- European Huntington's Disease Network (EHDN)Chieti, Italy
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
- Institute of Human Development, Faculty of Medical and Human Sciences, University of ManchesterManchester, United Kingdom
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science CentreManchester, United Kingdom
- Department of Neurology, Huntington-Center NRW, St. Josef-Hospital, Ruhr-UniversityBochum, Germany
- Department of Neurology, Medical University of SilesiaKatowice, Poland
- Department of Neurology, Institute of Psychiatry and NeurologyWarsaw, Poland
- KCR.S.A.Warsaw, Poland
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd HospitalStockholm, Sweden
- iCardiac TechnologiesRochester, NY, USA
- La Crocina Pharmaceutical Consultants D.I.San Giovanni d'Asso (S), Italy
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29
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Pili R, Carducci M, Brown P, Hurwitz H. An open-label study to determine the maximum tolerated dose of the multitargeted tyrosine kinase inhibitor CEP-11981 in patients with advanced cancer. Invest New Drugs 2014; 32:1258-68. [PMID: 25152243 PMCID: PMC4226840 DOI: 10.1007/s10637-014-0147-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/29/2014] [Indexed: 12/21/2022]
Abstract
Background This phase I study evaluated the pharmacokinetics and pharmacodynamics of CEP-11981, an oral vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor, in patients with advanced, relapsed, or refractory solid tumors. Methods Oral CEP-11981 dose escalations followed a modified Fibonacci sequence (from 3.0 to 4.2, 5.9, 11.8, 19.7, 29.6, 41.4, 55.0, 73.0, 97.4, and 126.6 mg/m2). The maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs), tumor response, and safety were evaluated. Results CEP-11981 was tolerated at doses between 3.0 and 97.4 mg/m2. The MTD of CEP-11981 was determined to be 97.4 mg/m2, with DLTs observed at the 126.6 mg/m2 dose. The DLTs were grade 4 neutropenia in 1 patient and grade 3 T-wave inversion with chest heaviness and fatigue in 1 patient. All 3 events resolved on stopping CEP-11981. The most frequently reported adverse events of any grade were fatigue, nausea, diarrhea, decreased appetite, abdominal pain, back pain, vomiting, constipation, headache, dizziness, and dyspnea. Treatment-related grade 3/4 neutropenia was observed in the highest-dose cohorts (2 patients at 97.4 mg/m2 and 1 patient at 126.6 mg/m2), indicating some off-target inhibition. VEGF inhibition was greatest in the higher-dose groups. Although no patient experienced complete or partial response, 44 % patients achieved stable disease when measured at ≥ 6 weeks, which occurred more frequently in cohorts receiving ≥ 73.0 mg/m2. Conclusions In patients with recurrent or refractory solid tumors, disease stabilization was achieved. Despite acceptable tolerability of CEP-11981 at the MTD, further development by the sponsor has ceased.
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Affiliation(s)
- Roberto Pili
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA,
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30
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Shah HA, Azam Z, Rauf J, Abid S, Hamid S, Jafri W, Khalid A, Ismail FW, Parkash O, Subhan A, Munir SM. Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial. J Hepatol 2014; 60:757-64. [PMID: 24291366 DOI: 10.1016/j.jhep.2013.11.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Esophageal variceal bleed is a major problem in patients with cirrhosis. Endoscopic variceal ligation (EVL) has been shown to be equal to or better than propranolol in preventing first bleed. Carvedilol is a non-selective β blocker with alpha-1 adrenergic blocker activity. Hemodynamic studies have shown carvedilol to be more effective than propranolol at reducing portal pressure. We compared efficacy of carvedilol with EVL for primary prophylaxis of esophageal variceal bleed. METHODS Cirrhotic patients with esophageal varices were randomized to carvedilol 12.5mg daily or EVL at three university hospitals of Pakistan. End points were esophageal variceal bleeding, death or liver transplant. RESULTS Two hundred and nine patients were evaluated. Eighty two and eighty six patients were randomized in carvedilol and EVL arms respectively. Mean age was 48 ± 12.2 years; 122 (72.7%) were males; 89.9% had viral cirrhosis; mean Child-Pugh score was 7.3 ± 1.6 and mean follow up was 13.3 ± 12.1 months (range 1-50 months). Both EVL and carvedilol groups had comparable variceal bleeding rates (8.5% vs. 6.9%), bleed related mortality (4.6% vs. 4.9%) and overall mortality (12.8% vs. 19.5%) respectively. Adverse events in carvedilol group were hypotension (n=2), requiring cessation of therapy, while transient nausea (n=18) and dyspnea (n=30) resolved spontaneously. In the EVL arm, post banding ulcer bleed (n=1) and chest pain (n=17), were termed as serious adverse events while transient dysphagia (n=58) resolved without treatment. CONCLUSIONS Although our study is underpowered, the findings suggest that carvedilol is probably not superior to EVL in preventing first variceal bleed in patients with viral cirrhosis.
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Affiliation(s)
- Hasnain Ali Shah
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.
| | - Zahid Azam
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Javeria Rauf
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Shahab Abid
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Saeed Hamid
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Wasim Jafri
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Abdullah Khalid
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Om Parkash
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Amna Subhan
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
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Mustafaev II, Nurmamedova GS. [Effect of monotherapy with nebivolol, bisoprolol, carvedilol on the state of vegetative nervous system and sexual function in men with arterial hypertension]. Kardiologiia 2013; 53:48-54. [PMID: 23548391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aim of the study was to assess effect of monotherapy with nebivolol, bisoprolol, carvedilol for 2 months on sexual function in men with arterial hypertension (AH). Men with 1-2 degree of AH (n=75, age 35-55 years, mean age 48+/-3,5 years) received monotherapy with these drugs for 2 months. Registration of parameters of heart rate variability (HRV), Dopplerography of penile arteries, and the Vasilchenko questionnaire were implemented at the end of 4 months of placebo period and after 2 months of therapy with a study drug. Therapy with bisoprolol, carvedilol, and nebivolol was associated with significant elevation of parasympathetic part of vegetative nervous system tone, improvement of systolic blood flow in cavernous and dorsal arteries. Analysis of data obtained by Vasilchenko questionnaire demonstrated improvement of psychic and erectile components of sexual function. Thus bisoprolol, carvedilol, and nebivolol did not worsen sexual function of men with AH, improved spectral parameters of HRV and vascular blood flow in arteries of cavernous bodies.
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Mitsikostas DD, Tfelt-Hansen P. Targeting to 5-HT1F receptor subtype for migraine treatment: lessons from the past, implications for the future. Cent Nerv Syst Agents Med Chem 2012; 12:241-9. [PMID: 22934751 DOI: 10.2174/187152412803760627] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 05/27/2012] [Revised: 07/16/2012] [Accepted: 08/27/2012] [Indexed: 11/22/2022]
Abstract
The effective anti-migraine drugs triptans, all bind with high affinity to three serotonin (5-HT) subtypes, the 5-HT1B, 5-HT1D and 5-HT1F. 5-HT1B mRNA is densely localized within smooth muscle, and less in the endothelium of cerebral blood vessels. This vascular distribution of 5-HT1B receptor has been shown to mediate the vasoconstrictive properties of the triptans, responsible for potential cardiac adverse events. Activation of 5-HT1D subtype, although effective in animal models of migraine, was not enough efficient to attenuate migraine attacks in clinical trials. The 5-HT1F receptor is located both in vessels and within the trigeminal ganglion (TG) and the trigeminal nucleus caudalis (Sp5C), but with the difference that the 5-HT1F receptor lack vasoconstrictive properties, making it an attractive target for new anti-migraine drugs. Selective activation of 5-HT1F receptor potently inhibited markers associated with electrical stimulation of the TG. Thus 5-HT1F receptor represents an ideal target for anti-migraine drugs. So far two selective 5-HT1F agonists have been tested in human trials for migraine: LY334370 and lasmiditan. Both molecules were efficient in attenuating migraine attacks with efficacy in the same range as oral sumatriptan 100mg, the gold standard for triptans. The LY334370 project withdrew because of toxicity in animals, while lasmiditan is still testing. In this review we present all the available preclinical and clinical data on the 5-HT1F agonists as a potential new class of anti-migraine drugs lacking vascular activity and we discuss related issues on the vascular and neuronal aspects of migraine pathogenesis.
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Affiliation(s)
- Dimos D Mitsikostas
- Neurology Department, Athens Naval Hospital, 77A V. Sofias Avenue, Athens 11521, Greece.
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Hidalgo R, Martí-Carvajal AJ, Kwong JSW, Simancas-Racines D, Nicola S. Pharmacological interventions for treating heart failure in patients with chagas cardiomyopathy. Cochrane Database Syst Rev 2012; 11:CD009077. [PMID: 23152267 DOI: 10.1002/14651858.cd009077.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 12/18/2022]
Abstract
BACKGROUND Chagas disease-related cardiomyopathy is a major cause of morbidity and mortality in Latin America. Despite the substantial burden to the healthcare system, there is uncertainty regarding the efficacy and safety of pharmacological interventions for treating heart failure in patients with Chagas disease. OBJECTIVES To assess the benefits and harms of current pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) Issue 1, 2011, MEDLINE (Ovid), EMBASE (Ovid), LILACS and ISI Web of Science to April 2011. We checked the reference lists of included papers. No language restrictions were applied. SELECTION CRITERIA We included randomized clinical trials assessing the effects of pharmacological interventions for treating heart failure in adult patients (≥18 years) with symptomatic heart failure (New York Heart Association class II to IV), irrespective of the left ventricular ejection fraction stage, reduced or preserved, with Chagas cardiomyopathy. No limits were applied with respect to the follow-up duration. Primary outcomes were all-cause mortality, cardiovascular mortality at 30 days, time to heart decompensation and disease-free period (at 30, 60 and 90 days), and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, risk of bias assessment and data extraction. We estimated relative risks (RR) and the respective 95% confidence intervals (CIs) for dichotomous outcomes. We measured statistical heterogeneity using the I(2) statistic. We used a fixed-effect model to synthesize the findings. We contacted authors for additional data. MAIN RESULTS We included two randomized clinical trials involving 69 participants. Both trials compared carvedilol against placebo, and had a high risk of bias. Carvedilol compared with placebo did not significantly affect all-cause mortality (2/34 (5.88%) versus 3/35 (5.87%); pooled RR 0.69, 95% CI 0.12 to 3.88, I(2) = 0%). None of the trials reported on cardiovascular mortality, time to heart decompensation or disease-free period. Evidence on the adverse effects of carvedilol is inconclusive. AUTHORS' CONCLUSIONS This Cochrane review has found a lack of evidence on the effects of carvedilol for treating heart failure in patients with Chagas disease. The two included trials were underpowered and had a high risk of bias. There are no conclusive data to support the use of carvedilol for treating Chagas cardiomyopathy. Unless randomized clinical trials provide evidence of a treatment effect, and the trade off between potential benefits and harms is established, policy-makers, clinicians, and academics should be cautious when recommending and administering carvedilol for treating heart failure in patients with Chagas disease. The efficacy and safety of other pharmacological interventions for treating heart failure in patients with Chagas disease is unknown.
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Affiliation(s)
- Ricardo Hidalgo
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
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Signorovitch JE, Samuelson TM, Ramakrishnan K, Marynchenko M, Wu EQ, Blum SI, Ramasamy A, Chen S. Persistence with nebivolol in the treatment of hypertension: a retrospective claims analysis. Curr Med Res Opin 2012; 28:591-9. [PMID: 22352883 DOI: 10.1185/03007995.2012.668495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/23/2022]
Abstract
OBJECTIVE Examine drug persistence by evaluating the hazard of discontinuation and of switching to different antihypertensive drugs in patients initiating treatment with a recently approved β-blocker, nebivolol, versus other β-blockers. METHODS This retrospective analysis included all patients diagnosed with hypertension in the MarketScan Database (January 2007 - December 2008) with at least two medical claims and no prior β-blocker prescriptions within 6 months of the initial prescription date. Multivariate Cox proportional hazard models (adjusted for baseline differences in demographics, previous use of other antihypertensive medications, initial doses and supply of medication, and number of distinct prescriptions at baseline) were used to assess the hazard of discontinuation, defined as the first prescription gap of ≥30 days, and to assess the hazard of switching to another antihypertensive drug, defined as a prescription fill for another antihypertensive drug within 15 days before and 30 days after discontinuation of the initial β-blocker. RESULTS Of the 173,200 patients included in the study population, the adjusted hazard of discontinuation for nebivolol-initiated patients was 8-20% lower than that of patients who initiated treatment with atenolol (hazard ratio [HR] 0.82, p < 0.001), metoprolol (HR 0.91, p < 0.001), carvedilol (HR 0.92, p < 0.001), or other β-blockers (HR 0.80, p < 0.001). The adjusted hazard of nebivolol-treated patients switching to a different antihypertensive medication was 12-22% lower than that of the other four β-blocker cohorts (atenolol: HR 0.80, p < 0.001; metoprolol: HR 0.86, p < 0.001; carvedilol: HR 0.88, p < 0.001; other β-blockers: HR 0.78, p < 0.001). Sensitivity analyses defined discontinuation as prescription gaps of ≥45 days and ≥60 days and showed a lower hazard of discontinuation among patients initiating nebivolol than among patients initiating all other drug cohorts (p < 0.001). LIMITATIONS Comparisons of non-randomized treatment groups may be confounded by unobserved differences in patients' baseline characteristics. CONCLUSIONS Initiation with nebivolol was associated with greater persistence than initiation with atenolol, carvedilol, metoprolol, or other β-blockers.
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Abstract
BACKGROUND This study investigated the risk of new-onset diabetes (NOD) among hypertensive patients initiating carvedilol therapy vs other beta-blocker (BB) therapy in a clinical practice setting. METHODS Patients aged ≥18 years with ≥1 pharmacy claim for a BB of interest (carvedilol immediate-release [IR]/controlled-release [CR], atenolol, metoprolol succinate, or metoprolol tartrate) were identified in the IMS LifeLink Health Plan Claims Database. Index date was the first chronologically occurring prescription for any BB during the enrollment period (July 1, 2000-December 31, 2007). Patients had to be continuously eligible to receive healthcare services 6 months prior to and a minimum of 3 months after index date and have ≥1 diagnostic code for hypertension (ICD-9-CM: 401.xx-405.xx) during this time frame. Patients were excluded for having a diagnosis of diabetes mellitus (ICD-9-CM: 250.xx) and/or prescription for antidiabetic therapy in the 6 months prior to and/or 3 months after index date. Eligible patients were propensity-score matched in a 1:3 ratio (carvedilol : other BBs). Mean duration of follow-up was 12.8 and 14.8 months for the carvedilol group and other BB group, respectively. Primary outcome of interest was presence and timing of NOD. RESULTS Among 3084 patients in the carvedilol group and 9252 in the other BB group, mean age was 56 years, with 54% male. NOD rate was 3.16 per 100 person-years for carvedilol patients vs 3.36 for patients in the other BB group (NS). Risk of NOD was similar between groups (HR 0.971, 95% CI: 0.78, 1.21; P = 0.792). CONCLUSIONS Findings suggest the risk of NOD among hypertensive patients is similar between carvedilol and other BB agents (i.e., atenolol, metoprolol succinate, or metoprolol tartrate). LIMITATIONS The use of administrative claims data and relatively short follow-up period may limit the generalizability of results.
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Affiliation(s)
- Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, LA, USA
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36
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Bartolini M, Giamberardino MA, Lisotto C, Martelletti P, Moscato D, Panascia B, Savi L, Pini LA, Sances G, Santoro P, Zanchin G, Omboni S, Ferrari MD, Brighina F, Fierro B. A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine. J Headache Pain 2011; 12:361-8. [PMID: 21437714 PMCID: PMC3094646 DOI: 10.1007/s10194-011-0325-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 02/21/2011] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to evaluate patients’ satisfaction with acute treatment of migraine with frovatriptan or almotriptan by preference questionnaire. One hundred and thirty three subjects with a history of migraine with or without aura (IHS 2004 criteria), with at least one migraine attack in the preceding 6 months, were enrolled and randomized to frovatriptan 2.5 mg or almotriptan 12.5 mg, treating 1–3 attacks. The study had a multicenter, randomized, double blind, cross-over design, with treatment periods lasting <3 months. At study end patients assigned preference to one of the treatments using a questionnaire with a score from 0 to 5 (primary endpoint). Secondary endpoints were pain free and pain relief episodes at 2 and 4 h, and recurrent and sustained pain free episodes within 48 h. Of the 133 patients (86%, intention-to-treat population) 114 of them expressed a preference for a triptan. The average preference score was not significantly different between frovatriptan (3.1 ± 1.3) and almotriptan (3.4 ± 1.3). The rates of pain free (30% frovatriptan vs. 32% almotriptan) and pain relief (54% vs. 56%) episodes at 2 h did not significantly differ between treatments. This was the case also at 4 h (pain free: 56% vs. 59%; pain relief: 75% vs. 72%). Recurrent episodes were significantly (P < 0.05) less frequent under frovatriptan (30% vs. 44%), also for the attacks treated within 30 min. No significant differences were observed in sustained pain free episodes (21% vs. 18%). The tolerability profile was similar between the two drugs. In conclusion, our study suggests that frovatriptan has a similar efficacy of almotriptan in the short-term, while some advantages are observed during long-term treatment.
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Affiliation(s)
| | | | - Carlo Lisotto
- Ospedale Civile San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | | | | | | | - Lidia Savi
- Department of Neurology, University of Torino, Turin, Italy
| | - Luigi Alberto Pini
- Inter Department Headache and Drug abuse Center, Modena University, Modena, Italy
| | | | | | - Giorgio Zanchin
- Department of Neurology, University of Padova, Padova, Italy
| | | | - Michel D. Ferrari
- Leiden Centre for Translational Neuroscience, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Filippo Brighina
- Department of Experimental Medicines and Neurological Sciences (BioNec), University of Palermo, Palermo, Italy
| | - Brigida Fierro
- Department of Experimental Medicines and Neurological Sciences (BioNec), University of Palermo, Via La Loggia 1, 90100 Palermo, Italy
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Ozova EM, Kiiakbaev GK, Kobalava ZD, Moiseev VS. [Effect of carvedilol and metoprolol R administered with or without atorvastatin on elastic properties of vascular wall and parameters of inflammation in patients with chronic heart failure of ischemic origin]. Kardiologiia 2011; 51:39-46. [PMID: 21623719] [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: 05/30/2023]
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Kelman L, Harper SQ, Hu X, Campbell JC. Treatment response and tolerability of frovatriptan in patients reporting short- or long-duration migraines at baseline. Curr Med Res Opin 2010; 26:2097-104. [PMID: 20642390 DOI: 10.1185/03007995.2010.503488] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Compare migraine duration with frovatriptan (versus baseline) in migraineurs reporting long- (24-72 h) or short-duration (<24 h) migraines at baseline. METHODS Post hoc analysis of two postmarketing surveillance studies of migraineurs in German primary care clinics using frovatriptan (2.5 mg) to treat a single migraine attack. Using case-report forms, physicians recorded migraine characteristics at baseline (aura, duration, frequency, severity) and with frovatriptan (duration, severity, and recurrence). Patients and physicians rated frovatriptan effectiveness and tolerability versus previous therapy; physicians recorded adverse reactions. The primary analysis was change in migraine duration with frovatriptan versus baseline. RESULTS At baseline, 44.2% (7178/16 253) and 55.8% (9075/16 253) of patients reported short- and long-duration migraines, respectively; long-duration migraines were more often frequent (> or =3/months; 55.5% [4893/8811] vs. 30.6% [2132/6973]; p < 0.001; 95% CI, 23.5-26.5%), severe (61.7% [5584/9047] vs. 33.9% [2427/7156]; p < 0.001; 95% CI, 26.3-29.3%), and accompanied by aura (46.8% [4199/8977] vs. 31.3% [2215/7088]; p < 0.001; 95% CI, 14.0-17.0%). Mean (SD) onset of frovatriptan effect was <1 h; 72.3% (11 592/16 040) of patients required only one frovatriptan tablet. With frovatriptan, patients were 26.8-fold more likely to experience decreased versus increased headache duration (p < 0.001; 95% CI, 23.5-30.2) and 76.5% of patients reporting long-duration migraines at baseline experienced short-duration migraines. Most patients (87-90%) and physicians (70-75%) rated frovatriptan more effective and tolerable than previous therapies. CONCLUSION Patients with more severe migraine characteristics at baseline were more likely to have attacks lasting > or =24 h. When using frovatriptan, patients were 26.8-fold more likely to experience decreased versus increased headache duration. Frovatriptan might be a good option for patients with long-duration or recurrent migraine attacks. The post hoc design and analysis of a single migraine attack are possible study limitations.
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MacGregor EA, Pawsey SP, Campbell JC, Hu X. Safety and tolerability of frovatriptan in the acute treatment of migraine and prevention of menstrual migraine: Results of a new analysis of data from five previously published studies. ACTA ACUST UNITED AC 2010; 7:88-108. [PMID: 20435272 DOI: 10.1016/j.genm.2010.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND Triptans are a recommended first-line treatment for moderate to severe migraine. OBJECTIVE Using clinical trial data, we evaluated the safety and tolerability of frovatriptan as acute treatment (AT) and as short-term preventive (STP) therapy for menstrual migraine (MM). METHODS Data from 2 Phase III AT trials (AT1: randomized, placebo controlled, 1 attack; AT2: 12-months, noncomparative, open label) and 3 Phase IIIb STP trials in MM (MMP1 and MMP2: randomized, placebo controlled, double blind, 3 perimenstrual periods; MMP3: open label, noncomparative, 12 perimenstrual periods) were analyzed. In AT1, patients treated each attack with frovatriptan 2.5 mg, sumatriptan 100 mg, or placebo. In AT2, they used frovatriptan 2.5 mg. In MMP1 and MMP2, women administered frovatriptan 2.5 mg for 6 days during the perimenstrual period, taking a loading dose of 2 or 4 tablets on day 1, followed by once-daily or BID frovatriptan 2.5 mg, respectively; in MMP3, they used BID frovatriptan 2.5 mg. In AT1, which was previously published in part, group differences in adverse events (AEs) were analyzed using the Fisher exact test, and response rates were compared using logistic regression. Post hoc analyses of sustained pain-free status with no AEs (SNAE) and sustained pain response with no AEs (SPRNAE) were performed using a 2-sample test for equality of proportions without continuity correction. For AT2 and the STP studies, data were summarized using descriptive statistics. Results of individual safety analyses for the STP studies were previously reported; the present report includes new results from a pooled analysis of MMP1 and MMP2 and a new analysis of MMP3 in which AEs were coded using Medical Dictionary for Regulatory Activities version 8.0. RESULTS AT1 included 1206 patients in the safety group; AT2 included 496. In the STP studies, safety data were collected for 1487 women. In AT1 and AT2, 85.6% and 88.3%, respectively, of enrolled patients were women. Overall, AEs were generally mild to moderate (AT studies: 82.3%-90.0%; STP studies: 78.9%89.5%). In AT1, 27.3% (131/480) of frovatriptan patients, 33.4% (161/482) of sumatriptan patients, and 14.8% (36/244) of placebo patients experienced an AE considered possibly or probably related to treatment (P < 0.001 for either drug vs placebo).There were no significant differences between frovatriptan and sumatriptan in SNAE at 4 to 24 hours or in SPRNAE at 2 to 24 hours or at 4 to 24 hours. In randomized, controlled STP trials for MM, AEs were reported by 57.8% (166/287, BID) and 63.4% (210/331, once daily) of frovatriptan users versus 62.8% (216/344) of placebo recipients. There were no consistent differences in AEs reported by patients with potential cardiovascular risk or in AEs related to the use of estrogencontaining contraceptives (ECCs). CONCLUSIONS In randomized controlled trials and 12-month open-label studies, frovatriptan was well tolerated in these women during AT and STP therapy for MM. Subgroup analyses provide preliminary evidence of tolerability in women using ECCs and in women with comorbidities that do not contraindicate triptan use but may be suggestive of cardiovascular risk.
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Babkin AP, Gladkikh VV, Pershukov IV, Gulaia GI. [Comparative eficacy of antihypertensive therapy in patients with arterial hypertension and various sensitivity to salt]. Kardiologiia 2010; 50:35-38. [PMID: 21118177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In 102 patients with high risk (52 patients with history of myocardial infarction, 50 patients with history of cerebral stroke within previous 6-48 months) arterial hypertension (AH) we studied clinical efficacy on angiotensin converting enzyme inhibitor (ACEI) lisinopril, calcium antagonist felodipine, and nonselective - -blocker carvedilol in dependence on salt sensitivity of AH. Efficacy of treatment was assessed with the help of office pressure measurement and 24 hour arterial pressure monitoring before and after 12 weeks of therapy. Patients who showed 10 or more mm Hg lowering of AP at transition from high salt (15 g/day) to low salt ( 3 g/day) diet were considered salt sensitive. On the basis of obtained results optimal for the treatment of AH in salt resistant patients are ACEI while in the treatment of salt sensitive patients it is expedient to administer calcium antagonists. The use of -adrenoblockers is equally effective in AH with various salt sensitivity.
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Latfullin IA, Ishmurzin GP, Gaĭfullina RF, Akhmerova RI, Kim ZF, Podol'skaia AA. [Beta-adrenoblockers for the correction of arterial hypertension in postmenopausal women]. Klin Med (Mosk) 2010; 88:68-71. [PMID: 21105477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The use of beta-blockers is an important component of therapy of cardiovascular pathology (e.g. coronary heart disease, arterial hypertension) in menopausal women. Comparative data on the efficiency of lokren and carvedilol for the correction of grade 2 AH are presented.
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Dowlati A, Posey J, Ramanathan RK, Rath L, Fu P, Chak A, Krishnamurthi S, Brell J, Ingalls S, Hoppel CL, Ivy P, Remick SC. Phase II and pharmacokinetic trial of rebeccamycin analog in advanced biliary cancers. Cancer Chemother Pharmacol 2009; 65:73-8. [PMID: 19399502 PMCID: PMC4220168 DOI: 10.1007/s00280-009-1005-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Advanced cancers of the bile duct and gallbladder carry an ominous prognosis. Rebeccamycin analogue (RA) is a novel antitumor antibiotic where phase I trials suggested clinical efficacy in patients with biliary cancers. METHODS The primary objective was to determine the response rate to RA in patients with advanced gallbladder and bile duct tumors. Secondary endpoints were survival and pharmacokinetic characterization. RA was given at a dose 165 mg/(m(2) day) x 5 days every 3 weeks. RESULTS Forty-six patients were enrolled. Nine patients were removed from study before their first planned imaging study for response. Two patients had partial responses and 16 had stable disease. On an intent-to-treat analysis the median survival was 6.3 months. A >20% drop in CA19.9 was seen in 43% of patients with initial high levels. Grade 4 neutropenia and thrombocytopenia were seen in 35 and 5% of patients, respectively. Febrile neutropenia occurred in 16% of patients. The pharmacokinetic profile of this trial closely resembles those of prior phase I trials. Measured biliary concentrations of RA were as much as 100x greater than simultaneous plasma concentration. CONCLUSION Although RA has a response rate of 5% in advanced biliary cancers, it is associated with significant numbers of patients experiencing prolonged stable disease. Biliary concentrations of RA are significantly greater than plasma concentrations.
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Affiliation(s)
- Afshin Dowlati
- University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Cady RK, Banks J, Jones BA, Campbell J. Postmarketing migraine survey of frovatriptan: effectiveness and tolerability vs previous triptans, NSAIDs or a combination. Curr Med Res Opin 2009; 25:2711-21. [PMID: 19778164 DOI: 10.1185/03007990903285449] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 11/23/2022]
Abstract
OBJECTIVE Compare the effectiveness and tolerability of current therapy with frovatriptan 2.5-mg tablets (in 1-3 migraines) in patients with migraine previously using other triptans, analgesics/nonsteroidal anti-inflammatory drugs (NSAIDs), or triptans and NSAIDs (T+NSAIDs). RESEARCH DESIGN AND METHODS Subanalysis of a postmarketing survey study in patients with migraine managed at primary care facilities in Germany. MAIN OUTCOME MEASURES A total of 5025 patients rated the effectiveness and tolerability of previous therapy (triptans; T+NSAIDs; NSAIDs) and current therapy with frovatriptan; physicians rated only frovatriptan effectiveness and tolerability (1 = Very Good, 2 = Good, 3 = Satisfactory, 4 = Poor). RESULTS Of 7107 patients initially surveyed, 5025 were identified for this subanalysis as previously using NSAIDs (n = 2890), triptans (n = 1418) or T + NSAIDs (n = 717). The mean (SD) age was 42.3 (11.9) years. At baseline, patients who previously used NSAIDs reported significantly fewer migraines per month, lower migraine severity, shorter migraine duration, and poorer ratings for effectiveness and tolerability versus responses from patients previously using triptans or T + NSAIDs (P < 0. 001 for each). Patient effectiveness ratings of Very Good or Good for previous therapy occurred in 49% (n = 691 of 1411) of patients using triptans, 27% (n = 195 of 716) of patients using T + NSAIDs, and 11% (n = 303 of 2866) of patients using NSAIDs (P < 0.04 between each group). Most patients rated current therapy with frovatriptan as Very Good or Good for effectiveness (86%, triptans; 83%, T + NSAIDs; 94%, NSAIDs) and tolerability (95%; 95%; 97%). Most physicians rated frovatriptan as Very Good or Good for effectiveness (87%; 86%; 95%) and tolerability (96%; 96%; 98%). Within-patient comparisons confirmed that frovatriptan had improved effectiveness (P < 0.001) and tolerability ratings (P < 0.001) in all three groups versus previous therapies. CONCLUSIONS Intrapatient comparisons showed that most patients with migraine reported significantly improved effectiveness and tolerability ratings with frovatriptan versus previous acute therapies.
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Affiliation(s)
- Roger K Cady
- Headache Care Center, 1230 E. Kingsley, Springfield, MO 65804, USA.
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Affiliation(s)
- Natalie J Carter
- Wolters Kluwer Health | Adis, Mairangi Bay, North Shore, Auckland, New Zealand.
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Askari H, Semizel E, Bostan OM, Cil E. Carvedilol therapy in pediatric patients with dilated cardiomyopathy. Turk J Pediatr 2009; 51:22-27. [PMID: 19378887] [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: 05/27/2023]
Abstract
Carvedilol reduces mortality and hospitalization in adults with congestive heart failure. Limited information is available about its use in children. The objective of this study was to determine the dosing, efficacy and side effects of carvedilol for the management of dilated cardiomyopathy in children. Sixteen children with idiopathic dilated cardiomyopathy, aged 7 months to 138 months and with an ejection fraction less than 40%, were treated with carvedilol. The average initial dose was 0.1 mg/kg/day and it was uptitrated to 0.4 mg/kg/day. After six months on carvedilol, there were improvements in clinical scoring system from an average of 2.94 to 2.50 (p<0.05), in mean fractional shortening from 17.2 +/- 6.1% to 22.7 +/- 5.1% (p<0.05), and in ejection fraction from 35.2 +/- 6.8% to 43.1 +/- 11.2% (p<0.05). No side effect was observed during the study period. Two patients died due to serious infection. Carvedilol in addition to standard therapy for dilated cardiomyopathy in children improves cardiac function and symptoms. It is well tolerated, with minimal adverse effects, but close monitoring is necessary.
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Affiliation(s)
- Hülya Askari
- Section of Cardiology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey
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Rifkin SI. Multiple drug interactions in a renal transplant patient leading to simvastatin-induced rhabdomyolysis: a case report. Medscape J Med 2008; 10:264. [PMID: 19099014 PMCID: PMC2605114] [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: 05/27/2023]
Abstract
Rhabdomyolysis, a syndrome characterized by muscle necrosis with release of toxic intracellular muscle constituents, can be a potentially fatal side effect of medical therapy. Here I report a patient with a 12-year history of simvastatin use who presented with rhabdomyolysis. He had a renal transplant and has been on a stable dose of cyclosporine for the past year. Recent medication changes were the addition of ranolazine, carvedilol, and diltiazem about two months prior to the episode of rhabdomyolysis. Discontinuation of the ranolazine, diltiazem, and simvastatin resulted in prompt resolution of the episode. It is suggested that these medications, acting in concert with cyclosporine, altered the metabolism of simvastatin, causing the episode of rhabdomyolysis. Clinicians should be alert to the possibility of multiple drug interactions causing rhabdomyolysis.
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Affiliation(s)
- Stephen I Rifkin
- Division of Nephrology, University of South Florida, College of Medicine, Tampa, Florida, USA.
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Frovatriptan: new drug. Migraine attacks: an unnecessary triptan. Less effective than sumatriptan, but more adverse effects. Prescrire Int 2008; 17:106. [PMID: 18623914] [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: 05/26/2023]
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Patanè S, Marte F, Di Bella G. Transient syncope, left bundle branch block and first degree atrioventricular block after “pill-in-the-pocket” administration. Int J Cardiol 2008; 126:e19-21. [PMID: 17408787 DOI: 10.1016/j.ijcard.2006.12.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 12/31/2006] [Indexed: 11/26/2022]
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