Metformin is now the most widely prescribed oral hypoglycemic agent. This review outlines its use in the treatment of type 2 diabetes. The main mechanisms of action include reduction of appetite and of intestinal carbohydrate absorption, inhibition of hepatic gluconeogenesis, and increased glucose uptake by peripheral tissues. Metformin has been established as the drug of choice for the first-line treatment of type 2 diabetes. According to broadly accepted guidelines, it should be administered early at diagnosis of this metabolic disorder, alongside diet and exercise. This agent may also be safely and efficaciously combined with all other oral hypoglycemic agents, enabling a useful additive effect. Additionally, it may be prescribed in conjunction with insulin. This combination aims to offset insulin resistance, reduce insulin requirements and minimize weight gain. Of greater importance, metformin has been consistently shown to have a favorable effect on cardiovascular risk factors and to improve cardiovascular outcomes. Interestingly, the efficacy of metformin is accompanied by excellent safety: caution is only needed to avoid the drug in patients with obvious contraindications (mainly chronic renal failure, congestive heart failure, chronic obstructive pulmonary disease, liver disease). Moreover, the cost-effectiveness of metformin has been established. Generally, metformin is an excellent choice both in the specialized setting and in primary health care.
{"title":"Metformin: A Review of Its Use in the Treatment of Type 2 Diabetes:","authors":"N. Papanas, E. Maltezos","doi":"10.4137/CMT.S1085","DOIUrl":"https://doi.org/10.4137/CMT.S1085","url":null,"abstract":"Metformin is now the most widely prescribed oral hypoglycemic agent. This review outlines its use in the treatment of type 2 diabetes. The main mechanisms of action include reduction of appetite and of intestinal carbohydrate absorption, inhibition of hepatic gluconeogenesis, and increased glucose uptake by peripheral tissues. Metformin has been established as the drug of choice for the first-line treatment of type 2 diabetes. According to broadly accepted guidelines, it should be administered early at diagnosis of this metabolic disorder, alongside diet and exercise. This agent may also be safely and efficaciously combined with all other oral hypoglycemic agents, enabling a useful additive effect. Additionally, it may be prescribed in conjunction with insulin. This combination aims to offset insulin resistance, reduce insulin requirements and minimize weight gain. Of greater importance, metformin has been consistently shown to have a favorable effect on cardiovascular risk factors and to improve cardiovascular outcomes. Interestingly, the efficacy of metformin is accompanied by excellent safety: caution is only needed to avoid the drug in patients with obvious contraindications (mainly chronic renal failure, congestive heart failure, chronic obstructive pulmonary disease, liver disease). Moreover, the cost-effectiveness of metformin has been established. Generally, metformin is an excellent choice both in the specialized setting and in primary health care.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"55 1","pages":"1367-1381"},"PeriodicalIF":0.0,"publicationDate":"2009-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78009977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bone loss and its associated risk of fracture is a serious long-term health issue for breast cancer and prostate cancer survivors. Hormone ablation therapy, in particular aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, causes marked reduction in circulating estrogen or testosterone levels, resulting in increased bone resorption, decreased bone mineral density (BMD), and an increased risk of fragility fracture. In several clinical trials with small sample sizes and short follow-up periods, oral and intravenous bisphosphonates have been shown to improve BMD, but not actual fracture rates, in cancer patients on hormone ablation therapy. A number of professional organizations and expert panels recommend the use of bisphosphonates for selected patients at risk. Although bisphosphonates are generally well tolerated, physicians should be aware of safety concerns, including the risk of osteonecrosis of the jaw. With the growing number of older breast and prostate cancer survivors, additional research is needed to characterize patients who would benefit from pharmacotherapy and optimize strategies to prevent cancer treatment-induced bone loss.
{"title":"Pharmacotherapy Options in Cancer Treatment-Induced Bone Loss: Focus on Bisphosphonates","authors":"Kouta Ito","doi":"10.4137/CMT.S2064","DOIUrl":"https://doi.org/10.4137/CMT.S2064","url":null,"abstract":"Bone loss and its associated risk of fracture is a serious long-term health issue for breast cancer and prostate cancer survivors. Hormone ablation therapy, in particular aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, causes marked reduction in circulating estrogen or testosterone levels, resulting in increased bone resorption, decreased bone mineral density (BMD), and an increased risk of fragility fracture. In several clinical trials with small sample sizes and short follow-up periods, oral and intravenous bisphosphonates have been shown to improve BMD, but not actual fracture rates, in cancer patients on hormone ablation therapy. A number of professional organizations and expert panels recommend the use of bisphosphonates for selected patients at risk. Although bisphosphonates are generally well tolerated, physicians should be aware of safety concerns, including the risk of osteonecrosis of the jaw. With the growing number of older breast and prostate cancer survivors, additional research is needed to characterize patients who would benefit from pharmacotherapy and optimize strategies to prevent cancer treatment-induced bone loss.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"61 1","pages":"1335-1350"},"PeriodicalIF":0.0,"publicationDate":"2009-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85687353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Curcio, L. Barcelona, W. Cornistein, C. Bantar, L. Barcan, P. Bonvehi, R. Reina, C. Bergallo, H. Biondi, J. Calderón, J. Castagnino, Paulo Chinchilla, M. Dignani, A. Esposto, Norma Pérez, C. Freuler, C. Luna, F. Ríos, C. Rodríguez, R. Valentini, W. Vazquez, S. Verbanaz, G. Vergara
Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, and multidrug-resistant-Acinetobacter spp. This medication has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI) and community-acquired bacterial pneumonia. Tigecycline’s pharmacological and microbiological profile has also encouraged physicians’ to use the drug in other infections caused by resistant pathogens featuring limited therapeutics options (i.e. hospital-acquired pneumonia-HAP). In this study we publish the conclusions of an expert panel that identify and evaluate the evidence to support the use of Tigecycline in hospitalized patients with one of the following three infections: cSSSI, cIAI and HAP, including ventilator-associated pneumonia. Based on this data the panel developed an Algorithm Rational to Prescribe Tigecycline (ART) for each pathology.
{"title":"Current Rational to Prescribe Tigecycline: Critical Analysis of the Evidence and Usage Algorithms by an Argentinean Experts Panel","authors":"D. Curcio, L. Barcelona, W. Cornistein, C. Bantar, L. Barcan, P. Bonvehi, R. Reina, C. Bergallo, H. Biondi, J. Calderón, J. Castagnino, Paulo Chinchilla, M. Dignani, A. Esposto, Norma Pérez, C. Freuler, C. Luna, F. Ríos, C. Rodríguez, R. Valentini, W. Vazquez, S. Verbanaz, G. Vergara","doi":"10.4137/CMT.S3312","DOIUrl":"https://doi.org/10.4137/CMT.S3312","url":null,"abstract":"Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, and multidrug-resistant-Acinetobacter spp. This medication has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI) and community-acquired bacterial pneumonia. Tigecycline’s pharmacological and microbiological profile has also encouraged physicians’ to use the drug in other infections caused by resistant pathogens featuring limited therapeutics options (i.e. hospital-acquired pneumonia-HAP). In this study we publish the conclusions of an expert panel that identify and evaluate the evidence to support the use of Tigecycline in hospitalized patients with one of the following three infections: cSSSI, cIAI and HAP, including ventilator-associated pneumonia. Based on this data the panel developed an Algorithm Rational to Prescribe Tigecycline (ART) for each pathology.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"59 1","pages":"1383-1398"},"PeriodicalIF":0.0,"publicationDate":"2009-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80784530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infliximab is a chimeric monoclonal antibody to human tumor necrosis factor alpha. While its use was developed in the treatment of rheumatologic diseases its effects on Crohn’s disease have revolutionized the management of this chronic illness. Infliximab has effects on both immune and epithelial cells leading to a reduction in gut inflammation and collagen deposition which promotes wound healing. Large randomized trials have proven efficacy of the drug in luminal and fistulizing Crohn’s disease. Over time our understanding of antibody formation and long-term tolerability of the drug have refined our use of infliximab, eliminating episodic dosing and utilizing concomitant immunomodulator therapy to improve efficacy. Questions remain regarding top-down strategies, length of therapy, cost, reduction in surgical procedures, and the determination of which patients will respond best to any strategy chosen.
{"title":"Infliximab: A Review of its Use in the Treatment of Crohn’s Disease","authors":"J. Molloy, Joel Z Stengel, Hays L. Arnold","doi":"10.4137/CMT.S2250","DOIUrl":"https://doi.org/10.4137/CMT.S2250","url":null,"abstract":"Infliximab is a chimeric monoclonal antibody to human tumor necrosis factor alpha. While its use was developed in the treatment of rheumatologic diseases its effects on Crohn’s disease have revolutionized the management of this chronic illness. Infliximab has effects on both immune and epithelial cells leading to a reduction in gut inflammation and collagen deposition which promotes wound healing. Large randomized trials have proven efficacy of the drug in luminal and fistulizing Crohn’s disease. Over time our understanding of antibody formation and long-term tolerability of the drug have refined our use of infliximab, eliminating episodic dosing and utilizing concomitant immunomodulator therapy to improve efficacy. Questions remain regarding top-down strategies, length of therapy, cost, reduction in surgical procedures, and the determination of which patients will respond best to any strategy chosen.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"6 1","pages":"1351-1365"},"PeriodicalIF":0.0,"publicationDate":"2009-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90792006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arformoterol tartrate is a newly developed long-acting ssβ2-agonist with both acute and prolonged bronchodilator effects. It is formed of 2 isomers (R,R/R,R) which distinguishes it from the more commonly used racemic formoterol (R,R/S,S). The active isomer is the (R,R) and in vitro arformoterol may have more potent anti-inflammatory effects than formoterol. It can only be given by a nebulizer. There have been 5 randomized, blinded trials which have assessed the use of arformoterol in chronic obstructive pulmonary disease (COPD). Arformoterol has been demonstrated to improve lung function and symptoms but the subjects tested did have a high degree of airway reactivity. The medication was well tolerated with a low incidence of side effects but the trials may not have been of sufficient duration to assess this adequately. Arformoterol should be used with caution in subjects with underlying cardiac disease. The current main use of arformoterol is in those subjects with COPD who require a long acting β2-agonist but who cannot use a dry powder or metered dose inhaler preparation. Arformoterol may only need to be given once a day and can be combined with other inhaled medication particularly tiotropium for additional benefit. It potentially has a role in the management of acute exacerbations.
{"title":"Pharmacotherapy of Chronic Obstructive Pulmonary Disease: Focus on Arformoterol Tartrate","authors":"P. King","doi":"10.4137/CMT.S2584","DOIUrl":"https://doi.org/10.4137/CMT.S2584","url":null,"abstract":"Arformoterol tartrate is a newly developed long-acting ssβ2-agonist with both acute and prolonged bronchodilator effects. It is formed of 2 isomers (R,R/R,R) which distinguishes it from the more commonly used racemic formoterol (R,R/S,S). The active isomer is the (R,R) and in vitro arformoterol may have more potent anti-inflammatory effects than formoterol. It can only be given by a nebulizer. There have been 5 randomized, blinded trials which have assessed the use of arformoterol in chronic obstructive pulmonary disease (COPD). Arformoterol has been demonstrated to improve lung function and symptoms but the subjects tested did have a high degree of airway reactivity. The medication was well tolerated with a low incidence of side effects but the trials may not have been of sufficient duration to assess this adequately. Arformoterol should be used with caution in subjects with underlying cardiac disease. The current main use of arformoterol is in those subjects with COPD who require a long acting β2-agonist but who cannot use a dry powder or metered dose inhaler preparation. Arformoterol may only need to be given once a day and can be combined with other inhaled medication particularly tiotropium for additional benefit. It potentially has a role in the management of acute exacerbations.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"537 1","pages":"1321-1327"},"PeriodicalIF":0.0,"publicationDate":"2009-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78882191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This is a review article that discusses the role of sildenafil in pediatric pulmonary hypertension. The etiopathogenesis as well as prognosis for pediatric pulmonary hypertension (PH) differs from adults. The basic tenets of targeted management of PH however are similar. Sildenafil and other phosphodiesterase-5 inhibitors play a very important role in PH management, especially because of the ease of administration, low adverse effect profile, better tolerability and relative cost effectiveness. This is especially vital in situations where inhaled nitric oxide is not easily available and fills an important therapeutic gap. Large double blinded and controlled studies studying the effects of sildenafil in pediatric PH are not available. Equally vital would be long term efficacy studies, which should be initiated through large multicenter trials, to study the beneficial as well as long term side effects of this medication in the pediatric age group.
{"title":"A Review of Sildenafil in the Treatment of Pediatric Pulmonary Arterial Hypertension","authors":"U. Krishnan, Leif Lovig","doi":"10.4137/CMT.S1959","DOIUrl":"https://doi.org/10.4137/CMT.S1959","url":null,"abstract":"This is a review article that discusses the role of sildenafil in pediatric pulmonary hypertension. The etiopathogenesis as well as prognosis for pediatric pulmonary hypertension (PH) differs from adults. The basic tenets of targeted management of PH however are similar. Sildenafil and other phosphodiesterase-5 inhibitors play a very important role in PH management, especially because of the ease of administration, low adverse effect profile, better tolerability and relative cost effectiveness. This is especially vital in situations where inhaled nitric oxide is not easily available and fills an important therapeutic gap. Large double blinded and controlled studies studying the effects of sildenafil in pediatric PH are not available. Equally vital would be long term efficacy studies, which should be initiated through large multicenter trials, to study the beneficial as well as long term side effects of this medication in the pediatric age group.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"6 1","pages":"1329-1333"},"PeriodicalIF":0.0,"publicationDate":"2009-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81201736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development of nelarabine as a therapeutic agent to treat various forms of hematologic malignancies spans more than 40 years. From the bench top to the bedside, basic scientists and clinical scientists in the pharmaceutical industry and academia collaborated with regulatory agencies to bring this drug to the market. Studies have demonstrated efficacy in treating T-cell leukemia and lymphoma and further work is ongoing as new dosing schedules of nelarabine and combinations with other chemotherapeutic agents are explored. This work is aimed at maximizing the therapeutic outcome while minimizing the potential neurotoxicity that has been identified with nelarabine. This brief review provides some of the “milestones” of development and presents a summary of the efforts of the pharmaceutical industry, academia, and government. Nelarabine, synthesized in the late 1970’s as a prodrug of 9-β-D-arabinofuranosylguanine (ara-G), is still undergoing rigorous clinical evaluations in an effort to identify its optimal use.
奈拉宾作为治疗各种形式的血液恶性肿瘤的药物的发展已有40多年的历史。从实验到临床，制药行业和学术界的基础科学家和临床科学家与监管机构合作，将这种药物推向市场。研究已经证明了奈拉滨治疗t细胞白血病和淋巴瘤的疗效，随着新的给药方案和与其他化疗药物的联合研究正在进行中。这项工作旨在最大限度地提高治疗效果，同时最大限度地减少奈拉宾已确定的潜在神经毒性。这篇简短的综述提供了一些发展的“里程碑”，并概述了制药业、学术界和政府的努力。Nelarabine是20世纪70年代末合成的9-β- d -阿拉伯糖基鸟嘌呤(ara-G)的前药，目前仍在进行严格的临床评估，以确定其最佳用途。
{"title":"Collaboration to Meet a Therapeutic Need: The Development of Nelarabine","authors":"D. Kisor","doi":"10.4137/CMT.S2909","DOIUrl":"https://doi.org/10.4137/CMT.S2909","url":null,"abstract":"The development of nelarabine as a therapeutic agent to treat various forms of hematologic malignancies spans more than 40 years. From the bench top to the bedside, basic scientists and clinical scientists in the pharmaceutical industry and academia collaborated with regulatory agencies to bring this drug to the market. Studies have demonstrated efficacy in treating T-cell leukemia and lymphoma and further work is ongoing as new dosing schedules of nelarabine and combinations with other chemotherapeutic agents are explored. This work is aimed at maximizing the therapeutic outcome while minimizing the potential neurotoxicity that has been identified with nelarabine. This brief review provides some of the “milestones” of development and presents a summary of the efforts of the pharmaceutical industry, academia, and government. Nelarabine, synthesized in the late 1970’s as a prodrug of 9-β-D-arabinofuranosylguanine (ara-G), is still undergoing rigorous clinical evaluations in an effort to identify its optimal use.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"21 1","pages":"1317-1320"},"PeriodicalIF":0.0,"publicationDate":"2009-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82236435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tigecycline is a first-in-class glycylcycline, broad-spectrum, intravenous antibacterial developed to overcome the two major mechanisms of tetracycline resistance (ribosomal protection and efflux). The drug has been approved in US for community-acquired bacterial pneumonia in adults. In vitro, tigecycline had good activity against a range of Gram-positive, Gram-negative and atypical community-acquired respiratory tract pathogens implicated in community-acquired pneumonia (CAP), including community-acquired Staphylococcus aureus, penicillin-resistant Streptococus pneumoniae and multidrug-resistant Enterobacteriaceae. Nonetheless, tigecycline shows in vitro low activity against against P. aeruginosa. Tigecycline provides high intrapulmonary concentrations that exceed the MIC90 of most of these respiratory pathogens. The combined results of two well designed, phase III studies demonstrated that tigecycline 100 mg initially, followed by 50 mg every 12 hours for 7–14 days was not inferior to recommended dosages of levofloxacin in the treatment of hospitalized patients with CAP. Clinical cure rates were 89.7% versus 86.3% in the clinically evaluable population and 81.0% versus 79.7% in the clinical modified intent-to-treat population. Tigecycline represents an appropriate choice for empirical monotherapy in the treatment of CAP, mainly in patients with risk factors for infections due to resistant bacteria.
{"title":"Tigecycline in the Treatment of Community-Acquired Pneumonia","authors":"D. Curcio","doi":"10.4137/CMT.S2351","DOIUrl":"https://doi.org/10.4137/CMT.S2351","url":null,"abstract":"Tigecycline is a first-in-class glycylcycline, broad-spectrum, intravenous antibacterial developed to overcome the two major mechanisms of tetracycline resistance (ribosomal protection and efflux). The drug has been approved in US for community-acquired bacterial pneumonia in adults. In vitro, tigecycline had good activity against a range of Gram-positive, Gram-negative and atypical community-acquired respiratory tract pathogens implicated in community-acquired pneumonia (CAP), including community-acquired Staphylococcus aureus, penicillin-resistant Streptococus pneumoniae and multidrug-resistant Enterobacteriaceae. Nonetheless, tigecycline shows in vitro low activity against against P. aeruginosa. Tigecycline provides high intrapulmonary concentrations that exceed the MIC90 of most of these respiratory pathogens. The combined results of two well designed, phase III studies demonstrated that tigecycline 100 mg initially, followed by 50 mg every 12 hours for 7–14 days was not inferior to recommended dosages of levofloxacin in the treatment of hospitalized patients with CAP. Clinical cure rates were 89.7% versus 86.3% in the clinically evaluable population and 81.0% versus 79.7% in the clinical modified intent-to-treat population. Tigecycline represents an appropriate choice for empirical monotherapy in the treatment of CAP, mainly in patients with risk factors for infections due to resistant bacteria.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"47 1","pages":"1275-1289"},"PeriodicalIF":0.0,"publicationDate":"2009-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85859020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary arterial hypertension (PAH) is a progressive disease leading to obstruction of the small pulmonary arteries. Currently, there are eight approved medications for PAH. This review article focuses on the mechanisms, clinical trials, efficacy, and safety profiles of each of the PAH medications. In addition, this review addresses combination PAH therapy, patient preference, and future therapies.
{"title":"present and prospective pharmacotherapies in pulmonary Arterial Hypertension","authors":"Jennifer A. Johnson, A. Hemnes","doi":"10.4137/CMT.S2108","DOIUrl":"https://doi.org/10.4137/CMT.S2108","url":null,"abstract":"Pulmonary arterial hypertension (PAH) is a progressive disease leading to obstruction of the small pulmonary arteries. Currently, there are eight approved medications for PAH. This review article focuses on the mechanisms, clinical trials, efficacy, and safety profiles of each of the PAH medications. In addition, this review addresses combination PAH therapy, patient preference, and future therapies.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"44 1","pages":"1307-1316"},"PeriodicalIF":0.0,"publicationDate":"2009-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90536375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treatment for hepatitis B (HBV), a global disease affecting over 400 million persons, has changed over the past 15 years. Many of the current treatments are oral therapies which suppress HBV viral load and improve liver-related outcomes. However, differences exist in the currently available therapies both in terms of potency and resistance. The newest HBV nucleotide to be approved for the treatment of hepatitis B is tenofovir disoproxil fumarate that when phosphorylated to its active form leads to DNA chain termination. Tenofovir is active against human immunodeficiency virus (HIV) and was approved for its treatment in 2001. It is also active against HBV and was approved for its treatment in 2008. Tenofovir has emerged as an effective and potent therapy against lamivudine resistant strains as well as wild type HBV. Tenofovir resistance to HBV is rare. Long-term use of tenofovir has been associated with renal and bone marrow toxicity in some HIV-infected patients. To date, this is the only oral therapy which is both potent and does not lead to viral resistance in both treatment naive and experienced patients. Further studies in HBV mono-infected persons are needed to evaluate long-term impact of tenofovir use.
{"title":"Pharmacotherapy of Chronic Hepatitis B in Adults: Focus on Tenofovir Disoproxil Fumarate","authors":"M. Jain, Cindy L. Zoellner, K. Garg","doi":"10.4137/CMT.S1161","DOIUrl":"https://doi.org/10.4137/CMT.S1161","url":null,"abstract":"Treatment for hepatitis B (HBV), a global disease affecting over 400 million persons, has changed over the past 15 years. Many of the current treatments are oral therapies which suppress HBV viral load and improve liver-related outcomes. However, differences exist in the currently available therapies both in terms of potency and resistance. The newest HBV nucleotide to be approved for the treatment of hepatitis B is tenofovir disoproxil fumarate that when phosphorylated to its active form leads to DNA chain termination. Tenofovir is active against human immunodeficiency virus (HIV) and was approved for its treatment in 2001. It is also active against HBV and was approved for its treatment in 2008. Tenofovir has emerged as an effective and potent therapy against lamivudine resistant strains as well as wild type HBV. Tenofovir resistance to HBV is rare. Long-term use of tenofovir has been associated with renal and bone marrow toxicity in some HIV-infected patients. To date, this is the only oral therapy which is both potent and does not lead to viral resistance in both treatment naive and experienced patients. Further studies in HBV mono-infected persons are needed to evaluate long-term impact of tenofovir use.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"14 1","pages":"1291-1305"},"PeriodicalIF":0.0,"publicationDate":"2009-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85154393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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