The renin-angiotensin system can be inhibited through inhibition of angiotensin I generation from angiotensinogen by direct renin inhibitors, inhibition of angiotensin II generation from angiotensin I by angiotensin-converting enzyme inhibitors and by direct inhibition of the action of angiotensin II receptor level. Aliskiren, the first direct renin inhibitor to reach the market, is a low molecular weight, orally active, hydrophilic nonpeptide. It blocks angiotensin I generation, while plasma renin concentration increases because the drugs blocks the negative feed-back exerted by angiotensin II on renin synthesis. Aliskiren is suitable for once-daily administration because of its long pharmacological half-life. Because of its mechanism of action, aliskiren may provide the additional opportunity to inhibit progression of atherosclerosis at tissue level. Hypertension is an approved indication for aliskiren, which is also promising for the treatment of heart failure and diabetic nephropathy. The efficacy of this drug on major clinical events is being tested in large ongoing clinical trials.
{"title":"Good News from Aliskiren","authors":"P. Verdecchia, F. Angeli, G. Reboldi","doi":"10.4137/CMT.S2862","DOIUrl":"https://doi.org/10.4137/CMT.S2862","url":null,"abstract":"The renin-angiotensin system can be inhibited through inhibition of angiotensin I generation from angiotensinogen by direct renin inhibitors, inhibition of angiotensin II generation from angiotensin I by angiotensin-converting enzyme inhibitors and by direct inhibition of the action of angiotensin II receptor level. Aliskiren, the first direct renin inhibitor to reach the market, is a low molecular weight, orally active, hydrophilic nonpeptide. It blocks angiotensin I generation, while plasma renin concentration increases because the drugs blocks the negative feed-back exerted by angiotensin II on renin synthesis. Aliskiren is suitable for once-daily administration because of its long pharmacological half-life. Because of its mechanism of action, aliskiren may provide the additional opportunity to inhibit progression of atherosclerosis at tissue level. Hypertension is an approved indication for aliskiren, which is also promising for the treatment of heart failure and diabetic nephropathy. The efficacy of this drug on major clinical events is being tested in large ongoing clinical trials.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"144 1","pages":"999-1002"},"PeriodicalIF":0.0,"publicationDate":"2009-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77493058","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}
Didanosine (ddI) has been used to treat HIV infection, in combination with other anti-retroviral drugs, for over 15 years. However, the use of the original formulation of ddI was limited by serious gastro-intestinal adverse effects, which were mainly attributable to the buffer used to protect ddI from the effect of gastric pH. Didanosine enteric-coated capsule (ddI-EC), a more recently introduced formulation, is less likely to cause gastrointestinal intolerance and its absorption might not be compromised by food intake. In this review we discuss efficacy of ddI-EC-containing anti-retroviral combinations (cART) both in naive and previously treated patients. Because of its favorable resistance profile, ddI-EC has been shown to be potentially efficacious in rescuing patients in virological failure, even if they have nucleoside reverse transcriptase inhibitors (NRTI)-associated resistance mutations. However, ddI has been shown as a potent inducer of mitochondrial dysfunction. Peripheral neuropathy, severe hyperlactatemia and pancreatitis have all been described in patients exposed to ddI. Close monitoring of patients on ddI-EC-containing cART and low threshold for treatment modifications are required to prevent major complications. In the context of once daily cART, ddI-EC is a valid option, particularly when other agents are not available, or when other medical conditions preclude the use of drugs such as tenofovir or abacavir. The role of ddI-EC in second line cART may be even more important in resource-limited settings where additional options are lacking.
{"title":"Safety and Efficacy of Didanosine Enteric-Coated Capsule in Patients with HIV-1 Infection","authors":"A. Arenas-Pinto","doi":"10.4137/CMT.S3049","DOIUrl":"https://doi.org/10.4137/CMT.S3049","url":null,"abstract":"Didanosine (ddI) has been used to treat HIV infection, in combination with other anti-retroviral drugs, for over 15 years. However, the use of the original formulation of ddI was limited by serious gastro-intestinal adverse effects, which were mainly attributable to the buffer used to protect ddI from the effect of gastric pH. Didanosine enteric-coated capsule (ddI-EC), a more recently introduced formulation, is less likely to cause gastrointestinal intolerance and its absorption might not be compromised by food intake. In this review we discuss efficacy of ddI-EC-containing anti-retroviral combinations (cART) both in naive and previously treated patients. Because of its favorable resistance profile, ddI-EC has been shown to be potentially efficacious in rescuing patients in virological failure, even if they have nucleoside reverse transcriptase inhibitors (NRTI)-associated resistance mutations. However, ddI has been shown as a potent inducer of mitochondrial dysfunction. Peripheral neuropathy, severe hyperlactatemia and pancreatitis have all been described in patients exposed to ddI. Close monitoring of patients on ddI-EC-containing cART and low threshold for treatment modifications are required to prevent major complications. In the context of once daily cART, ddI-EC is a valid option, particularly when other agents are not available, or when other medical conditions preclude the use of drugs such as tenofovir or abacavir. The role of ddI-EC in second line cART may be even more important in resource-limited settings where additional options are lacking.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"109 1","pages":"1263-1274"},"PeriodicalIF":0.0,"publicationDate":"2009-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91109202","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}
Allergic rhinitis and asthma are common disorders effecting large percentages of the population of Western countries. There are multiple treatment options available for allergic rhinitis and asthma and stepwise approaches to therapy have been recommended. Montelukast is a cysteinyl leukotriene receptor antagonist that has been found to be effective both in the treatment of allergic rhinitis and asthma. This paper will describe the pharmacology, safety, efficacy and tolerability of montelukast. It will examine the comparative efficacy of montelukast to other medications for the treatment of allergic rhinitis and asthma, as well as discuss the recent studies of combination therapy.
{"title":"Montelukast: Pharmacology, Safety, Tolerability and Efficacy","authors":"M. Benninger, H. H. Waters","doi":"10.4137/CMT.S1147","DOIUrl":"https://doi.org/10.4137/CMT.S1147","url":null,"abstract":"Allergic rhinitis and asthma are common disorders effecting large percentages of the population of Western countries. There are multiple treatment options available for allergic rhinitis and asthma and stepwise approaches to therapy have been recommended. Montelukast is a cysteinyl leukotriene receptor antagonist that has been found to be effective both in the treatment of allergic rhinitis and asthma. This paper will describe the pharmacology, safety, efficacy and tolerability of montelukast. It will examine the comparative efficacy of montelukast to other medications for the treatment of allergic rhinitis and asthma, as well as discuss the recent studies of combination therapy.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"312 1","pages":"1253-1261"},"PeriodicalIF":0.0,"publicationDate":"2009-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79697468","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}
Hypertension can lead to significant morbidity and mortality, and requires lifestyle modifications with or without drug therapy to achieve target blood pressure control. Various classes of anti-hypertensive medications are available to healthcare providers. Choice of medications is based not only on efficacy but also tolerability and cost. Aliskiren is the first drug of a new class of agents known as renin inhibitors. It is approved by the U.S. Food and Drug Administration (FDA) as monotherapy or combination therapy with other antihypertensive agents to optimize blood pressure control. Its efficacy in blood pressure reduction is superior to placebo and comparable to angiotensin receptor blockers, hydrochlorothiazide, angiotensin-converting-enzyme inhibitors and atenolol. It also offers additional blood pressure reduction when used in combination of other agents. Recently, a study demonstrated its efficacy and safety in the elderly, and a study suggested its renoprotective effects in patient who were already taking losartan. More clinical studies are awaited to assess its potential for cardiovascular disease risk reduction. This paper reviews the pharmacology, efficacy and safety of aliskiren for the treatment of hypertension.
{"title":"Aliskiren for the Treatment of Hypertension: An Update","authors":"Sum Lam, S. Saxena, L. Macina, PE Lester","doi":"10.4137/CMT.S1991","DOIUrl":"https://doi.org/10.4137/CMT.S1991","url":null,"abstract":"Hypertension can lead to significant morbidity and mortality, and requires lifestyle modifications with or without drug therapy to achieve target blood pressure control. Various classes of anti-hypertensive medications are available to healthcare providers. Choice of medications is based not only on efficacy but also tolerability and cost. Aliskiren is the first drug of a new class of agents known as renin inhibitors. It is approved by the U.S. Food and Drug Administration (FDA) as monotherapy or combination therapy with other antihypertensive agents to optimize blood pressure control. Its efficacy in blood pressure reduction is superior to placebo and comparable to angiotensin receptor blockers, hydrochlorothiazide, angiotensin-converting-enzyme inhibitors and atenolol. It also offers additional blood pressure reduction when used in combination of other agents. Recently, a study demonstrated its efficacy and safety in the elderly, and a study suggested its renoprotective effects in patient who were already taking losartan. More clinical studies are awaited to assess its potential for cardiovascular disease risk reduction. This paper reviews the pharmacology, efficacy and safety of aliskiren for the treatment of hypertension.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"40 1","pages":"727-734"},"PeriodicalIF":0.0,"publicationDate":"2009-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78966112","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}
Traditional first-line intervention in patients with type 2 diabetes and very poor glycemic control is insulin therapy or high doses of sulfanylureas if there is no evidence of volume depletion. This review assesses the efficacy and safety of rosiglitazone and metformin fixed dose combination (avandamet) as initial therapy in patients with uncontrolled type 2 diabetes. This combination therapy achieved significant reduction in A1c and fasting plasma glucose compared with either rosiglitazone or metformin monotherapy as demonstrated by various studies. This combination was generally well tolerated as initial therapy, with no new tolerability issue identified with the fixed-dose combination, with tolerability profile similar to metformin alone. The marked benefit of this combination is the product of the complementary actions of these two agents.
{"title":"Rosiglitazone Maleate and Metformin Hydrochloride in Fixed Combination: What Role in the Treatment of Type 2 Diabetes?","authors":"R. Farah","doi":"10.4137/CMT.S2389","DOIUrl":"https://doi.org/10.4137/CMT.S2389","url":null,"abstract":"Traditional first-line intervention in patients with type 2 diabetes and very poor glycemic control is insulin therapy or high doses of sulfanylureas if there is no evidence of volume depletion. This review assesses the efficacy and safety of rosiglitazone and metformin fixed dose combination (avandamet) as initial therapy in patients with uncontrolled type 2 diabetes. This combination therapy achieved significant reduction in A1c and fasting plasma glucose compared with either rosiglitazone or metformin monotherapy as demonstrated by various studies. This combination was generally well tolerated as initial therapy, with no new tolerability issue identified with the fixed-dose combination, with tolerability profile similar to metformin alone. The marked benefit of this combination is the product of the complementary actions of these two agents.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"55 1","pages":"1215-1225"},"PeriodicalIF":0.0,"publicationDate":"2009-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76005382","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}
Pegylated liposomal doxorubicin (PLD) is doxorubicin HCl encapsulated in long-circulating STEALTH® liposomes (Doxil®). PLD achieves good response rates and many patients maintain long-lasting stable disease (SD), which is one of the advantages. In addition, the clinical benefit is high in platinum-resistant disease, and PLD is thus considered to be the first option. PLD is associated with a number of adverse events, but these events are mild to moderate. PLD is safer for heavily pretreated patients than topotecan and gemcitabine due to mild bone-marrow toxicity, but that nonhematotoxity, such as PPE, stomatitis, mucositis, and other cutaneous reactions were the most common side effects attributable to PLD. Based on a review of previous studies, there are no differences in efficacy between 50 and 40 mg/m2 of PLD, therefore, a dose of 40 mg/m2 is preferable in patients with platinum-resistant disease to reduce adverse events. The 1-hour infusion schedule every 4 weeks makes PLD easy to administer. A rational approach to combine PLD with other drugs should take the slow accumulation and delayed peak of PLD in tumors into consideration. When combined with other useful agents, the lower dose of PLD (30 to 35 mg/m2) with a 3-week schedule may reduce severe PPE and stomatitis with negligible effects on the level of DI and the therapeutic efficacy.
{"title":"Pegylated Liposomal Doxorubicin for Advanced Ovarian Cancer in Women who are Refractory to Both Platinum- and Paclitaxel-Based Chemotherapy Regimens","authors":"T. Sugiyama, S. Kumagai","doi":"10.4137/CMT.S2219","DOIUrl":"https://doi.org/10.4137/CMT.S2219","url":null,"abstract":"Pegylated liposomal doxorubicin (PLD) is doxorubicin HCl encapsulated in long-circulating STEALTH® liposomes (Doxil®). PLD achieves good response rates and many patients maintain long-lasting stable disease (SD), which is one of the advantages. In addition, the clinical benefit is high in platinum-resistant disease, and PLD is thus considered to be the first option. PLD is associated with a number of adverse events, but these events are mild to moderate. PLD is safer for heavily pretreated patients than topotecan and gemcitabine due to mild bone-marrow toxicity, but that nonhematotoxity, such as PPE, stomatitis, mucositis, and other cutaneous reactions were the most common side effects attributable to PLD. Based on a review of previous studies, there are no differences in efficacy between 50 and 40 mg/m2 of PLD, therefore, a dose of 40 mg/m2 is preferable in patients with platinum-resistant disease to reduce adverse events. The 1-hour infusion schedule every 4 weeks makes PLD easy to administer. A rational approach to combine PLD with other drugs should take the slow accumulation and delayed peak of PLD in tumors into consideration. When combined with other useful agents, the lower dose of PLD (30 to 35 mg/m2) with a 3-week schedule may reduce severe PPE and stomatitis with negligible effects on the level of DI and the therapeutic efficacy.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"21 1","pages":"1227-1236"},"PeriodicalIF":0.0,"publicationDate":"2009-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73669257","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}
Denosumab is a human monoclonal antibody against RANKL. This antibody decreases bone turnover markers and increases bone mineral density (BMD) in postmenopausal women. In phase 3 studies including more than 1100 women, denosumab achieved greater increases in lumbar spine, total hip, distal 1/3 radius, and total BMD than alendronate 70 mg weekly. Recent data suggest that denosumab also decreases vertebral and non-vertebral fractures. This drug seems to be safe, although the most frequent side effects are arthralgia, back pain, and nasopharyngitis. No increased incidence of neoplasia has been found compared to placebo or alendronate. However, infections requiring inpatient treatment were more frequent in study groups treated with denosumab. These were common community acquired infections and were treated with standard antibiotics. No opportunistic infections were reported. Denosumab is a very promising new drug for the treatment of osteopenia and osteoporosis, and hopefully more long-term safety information and further fracture data will support its commercial use in the near future.
{"title":"Pharmacotherapy of Bone Loss in Postmenopausal Women: Focus on Denosumab","authors":"A. Román-González, Kathryn E. Ackerman","doi":"10.4137/CMT.S1089","DOIUrl":"https://doi.org/10.4137/CMT.S1089","url":null,"abstract":"Denosumab is a human monoclonal antibody against RANKL. This antibody decreases bone turnover markers and increases bone mineral density (BMD) in postmenopausal women. In phase 3 studies including more than 1100 women, denosumab achieved greater increases in lumbar spine, total hip, distal 1/3 radius, and total BMD than alendronate 70 mg weekly. Recent data suggest that denosumab also decreases vertebral and non-vertebral fractures. This drug seems to be safe, although the most frequent side effects are arthralgia, back pain, and nasopharyngitis. No increased incidence of neoplasia has been found compared to placebo or alendronate. However, infections requiring inpatient treatment were more frequent in study groups treated with denosumab. These were common community acquired infections and were treated with standard antibiotics. No opportunistic infections were reported. Denosumab is a very promising new drug for the treatment of osteopenia and osteoporosis, and hopefully more long-term safety information and further fracture data will support its commercial use in the near future.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"36 1","pages":"1131-1143"},"PeriodicalIF":0.0,"publicationDate":"2009-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85063833","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}
Myelodysplastic syndromes (MDS) are marked by progressive cytopenias and risk of transformation to acute myeloid leukemia. Supportive care with transfusions, antibiotics, and hematopoietic growth factors has long been the mainstay of therapy for MDS, given that most patients are not eligible for more intensive chemotherapy. The hypomethylating agent 5-azacitidine (AZA) was the first chemotherapeutic agent approved by the U.S. Food and Drug Administration for the treatment of MDS, and it represented a real advance in the management of the disease. In Phase III trials, azacitidine demonstrated a higher response rate and a longer overall survival compared to supportive care alone. Importantly, it is a well-tolerated drug that can be given IV or SC in various outpatient schedules. Future studies are expected to evaluate the activity of AZA in combination with other epigenetic modifying agents and to establish the relative efficacy of azacitidine and decitabine. This review summarizes the current treatment landscape in MDS and specifically addresses the role of azacitidine in the management of MDS.
{"title":"Azacitidine: A Review of its Use in the Management of Myelodysplastic Syndromes","authors":"P. Lammers, A. Cashen","doi":"10.4137/CMT.S1163","DOIUrl":"https://doi.org/10.4137/CMT.S1163","url":null,"abstract":"Myelodysplastic syndromes (MDS) are marked by progressive cytopenias and risk of transformation to acute myeloid leukemia. Supportive care with transfusions, antibiotics, and hematopoietic growth factors has long been the mainstay of therapy for MDS, given that most patients are not eligible for more intensive chemotherapy. The hypomethylating agent 5-azacitidine (AZA) was the first chemotherapeutic agent approved by the U.S. Food and Drug Administration for the treatment of MDS, and it represented a real advance in the management of the disease. In Phase III trials, azacitidine demonstrated a higher response rate and a longer overall survival compared to supportive care alone. Importantly, it is a well-tolerated drug that can be given IV or SC in various outpatient schedules. Future studies are expected to evaluate the activity of AZA in combination with other epigenetic modifying agents and to establish the relative efficacy of azacitidine and decitabine. This review summarizes the current treatment landscape in MDS and specifically addresses the role of azacitidine in the management of MDS.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"79 2 1","pages":"1189-1197"},"PeriodicalIF":0.0,"publicationDate":"2009-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89974759","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 dopamine agonist pramipexole (PRA) ((S)-2-Amino-4,5,6,7-tetrahydro-6-(propylamino) benzothiazole dihydrochloride; molecular formula C10H17N3S⋅2(HCl), is a D3 selective compound, approved in 1997 for the treatment of Parkinson disease and in 2006 for that of idiopathic restless legs syndrome (RLS). Because of its tolerability, safety and half-life, PRA is favored over levodopa and on the other ergot derivate dopamine agonists, and it is considered nowadays one of the first choices in the therapy of RLS. PRA is rapidly and completely absorbed after oral administration, its protein binding is around 15%, it is almost unaffected by hepatic metabolism and excreted by urine unchanged. PRA has a linear pharmacokinetics, with a half-life ranging between 8 and 14 hours. Double-blind, placebo-controlled studies demonstrated that PRA, even at low dosages and since the first nights of administration, is significantly effective on the typical sensitive symptoms of RLS, on the periodic leg movements during sleep, and in improving the quality of life of patients with RLS. A subjective improvement of sleep quality is usually also reported by the patients, but the polysomnographic assessment gave less solid results on objective sleep parameters. The most common PRA related side effects include headache, nausea and orthostatic hypotension. Data on the long-term therapy of PRA in RLS, and on the efficacy of PRA in symptomatic forms of RLS are warranted to better delineate the role of PRA in RLS treatment.
{"title":"Pharmacotherapy of Restless Legs Syndrome with Pramipexole","authors":"M. Manconi, L. Ferini-Strambi","doi":"10.4137/CMT.S2054","DOIUrl":"https://doi.org/10.4137/CMT.S2054","url":null,"abstract":"The dopamine agonist pramipexole (PRA) ((S)-2-Amino-4,5,6,7-tetrahydro-6-(propylamino) benzothiazole dihydrochloride; molecular formula C10H17N3S⋅2(HCl), is a D3 selective compound, approved in 1997 for the treatment of Parkinson disease and in 2006 for that of idiopathic restless legs syndrome (RLS). Because of its tolerability, safety and half-life, PRA is favored over levodopa and on the other ergot derivate dopamine agonists, and it is considered nowadays one of the first choices in the therapy of RLS. PRA is rapidly and completely absorbed after oral administration, its protein binding is around 15%, it is almost unaffected by hepatic metabolism and excreted by urine unchanged. PRA has a linear pharmacokinetics, with a half-life ranging between 8 and 14 hours. Double-blind, placebo-controlled studies demonstrated that PRA, even at low dosages and since the first nights of administration, is significantly effective on the typical sensitive symptoms of RLS, on the periodic leg movements during sleep, and in improving the quality of life of patients with RLS. A subjective improvement of sleep quality is usually also reported by the patients, but the polysomnographic assessment gave less solid results on objective sleep parameters. The most common PRA related side effects include headache, nausea and orthostatic hypotension. Data on the long-term therapy of PRA in RLS, and on the efficacy of PRA in symptomatic forms of RLS are warranted to better delineate the role of PRA in RLS treatment.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"02 1","pages":"1179-1188"},"PeriodicalIF":0.0,"publicationDate":"2009-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86088670","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}
Breast cancer remains the second leading cause of malignancy-related death in women in the United States, regardless of advances in novel therapeutic agents. High priority should be emphasized in research aimed at the study of pharmacological and natural compounds that may potentially prevent the development of breast cancer in susceptible patients. Among the known selective estrogen receptor modulators with proven chemopreventive effects, raloxifene has been studied in a number of clinical trials evaluating this drug for the prevention of osteoporosis and coronary heart disease. The MORE and CORE trials had as a primary end point the efficacy of raloxifene in the treatment of women with osteoporosis. These studies showed that raloxifene reduced the risk of invasive breast cancer in postmenopausal women. However, the STAR trial showed no significant difference between raloxifene and tamoxifen recipients in the incidence of invasive breast cancer in postmenopausal women at high risk of invasive breast cancer. This review focuses on the chemopreventive properties of raloxifene and the clinical trials that have proven its efficacy as a chemopreventive agent in invasive breast cancer.
{"title":"A Review of the Prevention of Invasive Breast Cancer with Raloxifene in Postmenopausal Women","authors":"B. Arango, A. Castrellon, E. Santos, S. Glück","doi":"10.4137/CMT.S2063","DOIUrl":"https://doi.org/10.4137/CMT.S2063","url":null,"abstract":"Breast cancer remains the second leading cause of malignancy-related death in women in the United States, regardless of advances in novel therapeutic agents. High priority should be emphasized in research aimed at the study of pharmacological and natural compounds that may potentially prevent the development of breast cancer in susceptible patients. Among the known selective estrogen receptor modulators with proven chemopreventive effects, raloxifene has been studied in a number of clinical trials evaluating this drug for the prevention of osteoporosis and coronary heart disease. The MORE and CORE trials had as a primary end point the efficacy of raloxifene in the treatment of women with osteoporosis. These studies showed that raloxifene reduced the risk of invasive breast cancer in postmenopausal women. However, the STAR trial showed no significant difference between raloxifene and tamoxifen recipients in the incidence of invasive breast cancer in postmenopausal women at high risk of invasive breast cancer. This review focuses on the chemopreventive properties of raloxifene and the clinical trials that have proven its efficacy as a chemopreventive agent in invasive breast cancer.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"178 1","pages":"1173-1178"},"PeriodicalIF":0.0,"publicationDate":"2009-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76853475","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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