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Research Progress on NMDA Receptor Enhancement Drugs for the Treatment of Depressive Disorder. 用于治疗抑郁症的 NMDA 受体增强药物的研究进展。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-08 DOI: 10.1007/s40263-024-01123-x
Ruyun Liu, Ning Liu, Lin Ma, Yue Liu, Zhuo Huang, Xiaodong Peng, Chunlin Zhuang, Jianguo Niu, Jianqiang Yu, Juan Du

Major depressive disorder (MDD) is a severe mental illness with a complex etiology. Currently, many medications employed in clinical treatment exhibit limitations such as delayed onset of action and a high incidence of adverse reactions. Therefore, there is a pressing need to develop antidepressants that exhibit enhanced efficacy and safety. The N-methyl-D-aspartate receptor (NMDAR), a distinctive glutamate-gated ion channel receptor, has been implicated in the onset and progression of depressive disorder, as evidenced by both preclinical and clinical research. The NMDAR antagonist, ketamine, exhibits rapid and sustained antidepressant effects, holding promise as a novel therapeutic approach for depressive disorder. However, its psychotomimetic impact and potential for addiction have restricted its widespread clinical application. Notably, over the past decade, studies have suggested that enhancing NMDAR functionality can produce antidepressant effects with improved safety, especially with the emergence of NMDAR-positive allosteric modulators (PAMs). We view this as a potential novel strategy for treating depression, forming the basis for the narrative review that follows.

重度抑郁障碍(MDD)是一种病因复杂的严重精神疾病。目前,临床治疗中使用的许多药物都存在起效延迟、不良反应发生率高等局限性。因此,开发疗效更好、安全性更高的抗抑郁药物迫在眉睫。N-甲基-D-天冬氨酸受体(NMDAR)是一种独特的谷氨酸门控离子通道受体,临床前研究和临床研究都证明,它与抑郁症的发生和发展有关。NMDAR 拮抗剂氯胺酮具有快速、持续的抗抑郁作用,有望成为治疗抑郁障碍的新型疗法。然而,氯胺酮的拟精神作用和潜在成瘾性限制了它在临床上的广泛应用。值得注意的是,在过去十年中,有研究表明,增强 NMDAR 的功能可以产生抗抑郁效果并提高安全性,特别是随着 NMDAR 阳性异位调节剂(PAMs)的出现。我们认为这是治疗抑郁症的一种潜在新策略,也是下文叙述性综述的基础。
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引用次数: 0
A Multicenter, Open-Label Study to Evaluate the Long-term Safety and Efficacy of Adjunctive Brexpiprazole 2 mg Daily in Japanese Patients with Major Depressive Disorder. 一项多中心、开放标签研究,旨在评估日本重度抑郁症患者每天服用 2 毫克布雷哌唑的长期安全性和有效性。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI: 10.1007/s40263-024-01124-w
Masaki Kato, Masako Shiosakai, Kazuo Kuwahara, Katsuhiro Iba, Yuki Shimada, Mizuki Saito, Daisuke Sekine, Kazuo Aoki, Yuki Shiomi, Teruhiko Higuchi
<p><strong>Background and objective: </strong>Inadequate response to antidepressant monotherapy is common among patients with major depressive disorder (MDD). The efficacy and safety of adjunctive brexpiprazole 2 mg/day has recently been confirmed during the 6-week, randomized, placebo-controlled phase 2/3 (BLESS) study, which evaluated brexpiprazole at 1 mg/day and 2 mg/day versus placebo as adjunctive therapy to antidepressant therapies in 740 Japanese patients with MDD and an inadequate response to antidepressant monotherapy. This study evaluated the long-term safety and efficacy of adjunctive fixed-dose brexpiprazole 2 mg/day in Japanese patients with MDD.</p><p><strong>Methods: </strong>An open-label, 52-week study enrolled rollover patients who completed the 6-week, double-blind, randomized, placebo-controlled phase 2/3 BLESS study (NCT03697603), and de novo patients aged ≥ 65 years. Patients were titrated to fixed-dose brexpiprazole 2 mg/day from Week 1. Safety assessments included treatment-emergent adverse events (TEAEs; primary outcome) and clinical and laboratory variables. Efficacy was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), Clinical Global Impression-Improvement (CGI-I) scale, Hamilton Depression Rating Scale (HAM-D) 17-item total score, and Sheehan Disability Scale (SDS) score.</p><p><strong>Results: </strong>In total, 247 patients [rollover, n = 216; de novo (previously unexposed), n = 31] were included in the safety/efficacy populations, and 138 (rollover, n = 132; de novo, n = 6; 55.9%) completed the study. Common TEAEs (incidence ≥ 10%) were weight gain [33.2% (n = 82)], akathisia [23.5% (n = 58)], nasopharyngitis [21.1% (n = 52)], and somnolence [10.5% (n = 26)]. TEAEs leading to treatment discontinuation occurred in 26.7% of patients receiving brexpiprazole and 58.1% of de novo patients. The mean (SD) increase in body weight from baseline to Week 52 [observed cases (OC)] was 4.2 (6.5) kg (n = 138); 44.5% (n = 110) had weight gain ≥ 7% at any postbaseline visit. There were no cases of tardive dyskinesia and no AEs related to suicide/suicide attempts. One death occurred (unknown cause), which was unrelated to study treatment. Improvements in the MADRS total score were observed from baseline over the course of the 52-week study [mean (SD) change at Week 52 (OC): - 7.3 (8.7)] for all patients receiving brexpiprazole. The overall MADRS response rate and remission rate in patients receiving brexpiprazole was 41.3% (n = 57) and 34.8% (n = 48), respectively, at Week 52 (OC). Improvements in CGI-S, HAM-D 17 item total score, and SDS mean scores were also observed from baseline over the 52-week study, with a mean (SD) change from baseline at Week 52 (OC) of - 0.8 (1.0), - 5.9 (6.3), and - 1.0 (2.2), respectively, indicating a sustained improvement in symptoms with long-term brexpiprazole treatment.</p><p><strong>Conclusions: </strong>This is the first study to evaluate the safety profile of brexpiprazole 2
背景和目的:在重度抑郁障碍(MDD)患者中,对抗抑郁药单一疗法反应不充分的情况很常见。最近,为期6周的随机安慰剂对照2/3阶段(BLESS)研究证实了2毫克/天的布来哌唑辅助治疗的有效性和安全性,该研究评估了1毫克/天和2毫克/天的布来哌唑与安慰剂作为抗抑郁疗法辅助治疗的效果,740名日本重度抑郁障碍患者接受了该研究,但对抗抑郁单药治疗反应不佳。本研究评估了日本MDD患者服用固定剂量布来匹唑2毫克/天的长期安全性和有效性:这项为期52周的开放标签研究招募了完成6周双盲、随机、安慰剂对照2/3期BLESS研究(NCT03697603)的转回患者,以及年龄≥65岁的新患者。患者从第1周开始接受固定剂量的布来哌唑治疗,剂量为2毫克/天。安全性评估包括治疗突发不良事件(TEAEs;主要结果)以及临床和实验室变量。疗效评估采用蒙哥马利-阿斯伯格抑郁评定量表(MADRS)、临床总体印象-改善(CGI-I)量表、汉密尔顿抑郁评定量表(HAM-D)17项总分和希恩残疾量表(SDS)评分:共有 247 名患者[滚动,n = 216;从头开始(以前未接触过),n = 31]被纳入安全性/有效性人群,138 人(滚动,n = 132;从头开始,n = 6;55.9%)完成了研究。常见的TEAEs(发生率≥10%)为体重增加[33.2%(n = 82)]、运动障碍[23.5%(n = 58)]、鼻咽炎[21.1%(n = 52)]和嗜睡[10.5%(n = 26)]。26.7%的接受布来哌唑治疗的患者和58.1%的新患者出现了导致停药的TEAE。从基线到第52周,体重增加的平均值(标度)[观察病例(OC)]为4.2(6.5)千克(n = 138);44.5%(n = 110)的患者在基线后的任何访视中体重增加≥7%。无迟发性运动障碍病例,无与自杀/自杀未遂相关的AEs。有一例死亡病例(原因不明)与研究治疗无关。在为期52周的研究过程中,所有接受布来哌唑治疗的患者的MADRS总分均较基线有所改善[第52周(OC)的平均(标度)变化:- 7.3 (8.7)]。在第52周(OC),接受布来哌唑治疗的患者的MADRS总体反应率和缓解率分别为41.3%(n = 57)和34.8%(n = 48)。在为期52周的研究中,还观察到CGI-S、HAM-D 17项总分和SDS平均分与基线相比有所改善,第52周(OC)与基线相比的平均(标清)变化分别为-0.8(1.0)、-5.9(6.3)和-1.0(2.2),这表明布雷克普拉唑的长期治疗可持续改善症状:这是首次评估日本MDD患者(包括老年人)使用2 mg/天的布来哌唑安全性的研究,其安全性与之前的报告相似,没有新的安全风险,疗效可持续52周:ClinicalTrials.gov(NCT03737474;2018年7月29日注册)。
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引用次数: 0
Recent Advances in Pharmacologic Treatments of Drug-Resistant Epilepsy: Breakthrough in Sight. 药物治疗耐药性癫痫的最新进展:突破在望。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-21 DOI: 10.1007/s40263-024-01130-y
Pavel Klein, Daniel Friedman, Patrick Kwan

Epilepsy affects approximately 1% of the world population. Patients have recurrent seizures, increased physical and psychiatric comorbidities, and higher mortality rate than the general population. Over the last 40 years, research has resulted in 20 new antiseizure medications (ASMs) approved between 1990 and 2018. In spite of this, up to one-third of patients (~ 1 million patients in the USA) have drug-resistant epilepsy (DRE), with little change between 1982 and 2018, a period of intense new ASM development. A minority of patients with DRE may benefit from surgical treatment, but this specialized care remains challenging to scale. Therefore, the greatest hope for breakthroughs for patients with DRE is in pharmacologic therapies. Recently, several advances promise to change the outcomes for patients with DRE. Cenobamate, a drug with dual mechanisms of modulating sodium channel currents and GABA-A receptors, achieves 90-100% seizure reduction in 25-33% of patients with focal DRE, a response not observed with other ASMs. Fenfluramine, a serotonin-acting drug, dramatically reduces the frequency of convulsive seizures in Dravet syndrome, a devastating developmental epileptic encephalopathy with severe DRE. Both drugs reduce mortality. In addition, the possibility of DRE prevention was recently raised in patients with tuberous sclerosis complex, a relatively common genetic form of epilepsy. A paradigm shift is emerging in the treatment of epilepsy. Seizure freedom has become attainable in a significant proportion of patients with focal DRE, and dramatic seizure reduction has been achieved in a developmental encephalopathy. Coupled with a rich pipeline of new compounds under clinical development, the long sought-after breakthrough in the treatment of epilepsy may finally be in sight.

全世界约有 1%的人患有癫痫。与普通人群相比,患者癫痫反复发作,身体和精神并发症增多,死亡率较高。在过去的 40 年中,研究人员在 1990 年至 2018 年间批准了 20 种新型抗癫痫药物(ASM)。尽管如此,仍有多达三分之一的患者(美国约 100 万患者)患有耐药性癫痫(DRE),1982 年至 2018 年期间几乎没有变化,而这一时期正是新抗癫痫药物的密集研发期。少数 DRE 患者可能会从手术治疗中获益,但这种专科治疗的规模仍具有挑战性。因此,DRE 患者取得突破的最大希望在于药物疗法。最近,有几项进展有望改变 DRE 患者的治疗效果。塞诺巴马特(Cenobamate)是一种具有调节钠通道电流和 GABA-A 受体双重机制的药物,可使 25% 至 33% 的局灶性 DRE 患者的癫痫发作减少 90% 至 100%,这是其他 ASMs 无法观察到的反应。芬氟拉明是一种5-羟色胺作用药物,可显著降低德雷维综合征的抽搐发作频率,德雷维综合征是一种具有严重DRE的破坏性发育性癫痫脑病。这两种药物都能降低死亡率。此外,最近有人提出了在结节性硬化综合征(一种相对常见的遗传性癫痫)患者中预防 DRE 的可能性。癫痫的治疗模式正在发生转变。相当一部分局灶性 DRE 患者已经可以摆脱癫痫发作,发育性脑病患者的癫痫发作也大幅减少。再加上临床开发中的大量新化合物,癫痫治疗领域寻求已久的突破终于有望实现。
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引用次数: 0
Efficacy of Cariprazine in the Psychosis Spectrum: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials in Schizophrenia and Bipolar Disorder. 卡利普嗪对精神病谱系的疗效:精神分裂症和躁狂症随机对照试验的系统回顾和网络元分析》。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-09 DOI: 10.1007/s40263-024-01125-9
Livio Tarchi, Susan Bugini, Cristiano Dani, Emanuele Cassioli, Eleonora Rossi, Stefano Lucarelli, Valdo Ricca, Saverio Caini, Giovanni Castellini

Background and objective: Psychosis represents one of the most challenging clinical presentations in psychiatry. Schizophrenia and bipolar disorder may both present psychotic features, and cariprazine may offer improvement in the treatment and care of these conditions. Therefore, the objective of the current work was to synthesise results of efficacy for cariprazine in these disorders.

Methods: In total, five electronic databases were searched for randomized controlled trials enrolling patients across the psychosis spectrum, using the search term 'Cariprazine' (PubMed, Embase, clinicaltrials.gov, EUDRACT, Cochrane-last search January 2024). No filter or limits were employed. Effect sizes were extracted, by the mean difference in psychometric variables before and after the intervention (Clinical Global Impression Scale, Positive and Negative Symptom Scale, Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, Hamilton Anxiety Rating Scale).

Results: In total, 12 studies enrolling either patients with schizophrenia or bipolar disorder were included (total n = 6477; n = 4814 patients treated with cariprazine, n = 1663 controls treated with placebo). Cariprazine was effective in reducing global clinical severity, and higher improvements were observed at increasing dosages (- 0.25 at ≤ 1.5 mg/day, - 0.45 at ≥ 3 mg/day). Cariprazine also effectively reduced psychotic total scores: - 6.74, [95% confidence interval (CI) - 8.31; - 5.17], depression: - 1.78, [95% CI - 2.54; - 1.02], mania: - 5.72, [95% CI - 6.95; - 4.49], and anxiety symptoms: - 1.24, [95% CI - 1.92; - 0.56].

Conclusions: Cariprazine was observed as efficacious across retrieved studies, offering a potential for tailored treatments across the psychosis spectrum.

Registration number: https://osf.io/pmyhq .

背景和目的:精神病是精神病学中最具挑战性的临床表现之一。精神分裂症和双相情感障碍都可能表现出精神病特征,而开浦嗪可以改善这些疾病的治疗和护理。因此,本次研究的目的是综合卡哌嗪对这些疾病的疗效结果:使用检索词 "Cariprazine"(PubMed、Embase、clinicaltrials.gov、EUDRACT、Cochrane--最后检索日期为 2024 年 1 月)在五个电子数据库中检索了纳入各种精神病患者的随机对照试验。未使用过滤或限制。根据干预前后心理测量变量(临床总体印象量表、阳性和阴性症状量表、蒙哥马利-阿斯伯格抑郁分级量表、青年躁狂分级量表、汉密尔顿焦虑分级量表)的平均差异提取效应大小:共有12项研究纳入了精神分裂症或躁狂症患者(总人数为6477人;接受卡哌嗪治疗的患者人数为4814人,接受安慰剂治疗的对照组人数为1663人)。卡利普嗪能有效降低总体临床严重程度,剂量越大,改善程度越高(≤1.5毫克/天时为-0.25,≥3毫克/天时为-0.45)。卡利普嗪还能有效降低精神病总分:- 6.74,[95% 置信区间 (CI) - 8.31; - 5.17];抑郁:- 1.78,[95% CI - 2.54; - 1.02];躁狂:- 5.72,[95% CI - 6.95; - 4.49];焦虑症状:- 1.24,[95% CI - 1.92; - 0.56]:在所有检索到的研究中,卡利普嗪被认为具有疗效,为整个精神病谱系的定制治疗提供了可能性。注册号:https://osf.io/pmyhq 。
{"title":"Efficacy of Cariprazine in the Psychosis Spectrum: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials in Schizophrenia and Bipolar Disorder.","authors":"Livio Tarchi, Susan Bugini, Cristiano Dani, Emanuele Cassioli, Eleonora Rossi, Stefano Lucarelli, Valdo Ricca, Saverio Caini, Giovanni Castellini","doi":"10.1007/s40263-024-01125-9","DOIUrl":"10.1007/s40263-024-01125-9","url":null,"abstract":"<p><strong>Background and objective: </strong>Psychosis represents one of the most challenging clinical presentations in psychiatry. Schizophrenia and bipolar disorder may both present psychotic features, and cariprazine may offer improvement in the treatment and care of these conditions. Therefore, the objective of the current work was to synthesise results of efficacy for cariprazine in these disorders.</p><p><strong>Methods: </strong>In total, five electronic databases were searched for randomized controlled trials enrolling patients across the psychosis spectrum, using the search term 'Cariprazine' (PubMed, Embase, clinicaltrials.gov, EUDRACT, Cochrane-last search January 2024). No filter or limits were employed. Effect sizes were extracted, by the mean difference in psychometric variables before and after the intervention (Clinical Global Impression Scale, Positive and Negative Symptom Scale, Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, Hamilton Anxiety Rating Scale).</p><p><strong>Results: </strong>In total, 12 studies enrolling either patients with schizophrenia or bipolar disorder were included (total n = 6477; n = 4814 patients treated with cariprazine, n = 1663 controls treated with placebo). Cariprazine was effective in reducing global clinical severity, and higher improvements were observed at increasing dosages (- 0.25 at ≤ 1.5 mg/day, - 0.45 at ≥ 3 mg/day). Cariprazine also effectively reduced psychotic total scores: - 6.74, [95% confidence interval (CI) - 8.31; - 5.17], depression: - 1.78, [95% CI - 2.54; - 1.02], mania: - 5.72, [95% CI - 6.95; - 4.49], and anxiety symptoms: - 1.24, [95% CI - 1.92; - 0.56].</p><p><strong>Conclusions: </strong>Cariprazine was observed as efficacious across retrieved studies, offering a potential for tailored treatments across the psychosis spectrum.</p><p><strong>Registration number: </strong>https://osf.io/pmyhq .</p>","PeriodicalId":10508,"journal":{"name":"CNS drugs","volume":" ","pages":"961-971"},"PeriodicalIF":7.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term (12-Month) Safety and Tolerability of STS101 (Dihydroergotamine Nasal Powder) in the Acute Treatment of Migraine: Data from the Phase 3 Open-Label ASCEND Study. STS101(二氢麦角胺鼻用粉剂)急性治疗偏头痛的长期(12 个月)安全性和耐受性:来自 3 期开放标签 ASCEND 研究的数据。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-07 DOI: 10.1007/s40263-024-01118-8
Stewart J Tepper, Detlef Albrecht, Jessica Ailani, Louis Kirby, Shannon Strom, Alan M Rapoport

Background and objective: STS101 is an investigational drug-device combination comprising 5.2 mg dihydroergotamine (DHE) powder (6.0 mg DHE mesylate) in a single-use nasal delivery device for the acute treatment of migraine. The primary objective of the ASCEND trial was to assess long-term safety and tolerability of STS101 in the acute treatment of migraine attacks across 12-18 months, with secondary objectives describing efficacy.

Methods: ASCEND was an open-label study of STS101 in adults aged 18-65 years with a ≥ 1 year history of migraine with or without aura, with onset before the age of 50 years and 4-12 migraine attacks/month and < 15 headache days/month in each of the 3 months prior to screening. Exclusion criteria included diagnosis of non-migraine headache, history of cerebrovascular disease, and ≥ 2 cardiovascular risk factors. After establishing eligibility, participants could self-administer STS101 5.2 mg as needed for up to 2 doses within 24 h to treat a single migraine attack and up to 12 doses/month. Safety and tolerability evaluations included physical and nasal examinations, vital signs, laboratory tests, and treatment-emergent adverse event (TEAE) assessments. Participants used an electronic diary to record exploratory efficacy parameters, including intensity of headache pain and associated migraine symptoms (photophobia, phonophobia, and nausea). Participant impression questions were asked at months 3, 6, and 12.

Results: Of the 6610 migraine attacks treated with a total of 8234 STS101 doses in 344 participants, 945/6610 (14.3%) were associated with a TEAE. Events were predominantly mild or moderate in nature and rarely led to premature study discontinuation (15/344 [4.4%] participants). Treatment was associated with rapid onset of freedom from pain (36.6%, 67.1%, and 85.5% of treated attacks 2, 4, and 24 h post-dose, respectively), freedom from most bothersome symptoms (54.3%, 79.6%, and 91.3%), and headache relief (66.5%, 89.1%, and 94.3%). Most participants rated treatment results as good or very good and ease of use as easy or very easy at all time points (months 3, 6, and 12) and indicated they were likely or very likely to use STS101 again.

Conclusions: The repeated long-term, as-needed use of STS101 was well tolerated, demonstrating a favorable safety profile in the acute treatment of migraine attacks in appropriately indicated adults. Exploratory efficacy evaluations indicated beneficial effects, which warrant further evaluation.

Trial registration: ClinicalTrials.gov identification NCT04406649.

背景和目的:STS101是一种用于偏头痛急性治疗的研究性药物-装置组合,由5.2毫克双氢麦角胺(DHE)粉末(6.0毫克甲磺酸DHE)装入一次性使用的鼻腔给药装置中。ASCEND试验的首要目标是评估STS101在12-18个月内急性治疗偏头痛发作的长期安全性和耐受性,次要目标是描述疗效:ASCEND是一项对STS101的开放标签研究,研究对象为18-65岁、有或无先兆偏头痛病史≥1年、50岁以前发病、偏头痛发作次数为4-12次/月、筛查前3个月内头痛天数<15天/月的成年人。排除标准包括非偏头痛头痛诊断、脑血管疾病史以及≥2个心血管风险因素。确定资格后,参与者可根据需要自行服用 STS101 5.2 毫克,24 小时内最多服用 2 次,以治疗单次偏头痛发作,每月最多服用 12 次。安全性和耐受性评估包括体格和鼻腔检查、生命体征、实验室检查和治疗突发不良事件(TEAE)评估。参与者使用电子日记记录探索性疗效参数,包括头痛疼痛强度和相关偏头痛症状(畏光、畏声和恶心)。在第 3、6 和 12 个月时还会询问参与者的印象问题:344名参与者共使用8234次STS101治疗了6610次偏头痛发作,其中945次/6610次(14.3%)与TEAE有关。这些事件主要为轻度或中度,很少导致过早终止研究(15/344 [4.4%] 参与者)。治疗过程中,患者很快就能摆脱疼痛(分别有 36.6%、67.1% 和 85.5% 的患者在服药后 2、4 和 24 小时内发病),摆脱大多数令人烦恼的症状(分别有 54.3%、79.6% 和 91.3%),头痛症状也有所缓解(分别有 66.5%、89.1% 和 94.3%)。大多数参与者在所有时间点(第 3、6 和 12 个月)都将治疗效果评为好或非常好,将使用简便性评为容易或非常容易,并表示他们很可能或非常可能再次使用 STS101:结论:长期按需重复使用 STS101 的耐受性良好,在急性期治疗偏头痛发作时,对有适当适应症的成人具有良好的安全性。探索性疗效评估表明该药具有有益作用,值得进一步评估:试验注册:ClinicalTrials.gov 鉴定 NCT04406649。
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引用次数: 0
Author's Reply to Zhou et al: Comment on "Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population". 作者对 Zhou 等人:"抗降钙素基因相关肽药物对前庭性偏头痛的疗效:亚洲人群的回顾性队列研究 "发表的评论。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-22 DOI: 10.1007/s40263-024-01135-7
Toru Miwa
{"title":"Author's Reply to Zhou et al: Comment on \"Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population\".","authors":"Toru Miwa","doi":"10.1007/s40263-024-01135-7","DOIUrl":"https://doi.org/10.1007/s40263-024-01135-7","url":null,"abstract":"","PeriodicalId":10508,"journal":{"name":"CNS drugs","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on "Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population". 关于 "抗降钙素基因相关肽药物对前庭性偏头痛的疗效:亚洲人群的回顾性队列研究 "发表评论。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-22 DOI: 10.1007/s40263-024-01134-8
Xin Zhou, Aiping Zhang, Riyang Lin
{"title":"Comment on \"Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population\".","authors":"Xin Zhou, Aiping Zhang, Riyang Lin","doi":"10.1007/s40263-024-01134-8","DOIUrl":"10.1007/s40263-024-01134-8","url":null,"abstract":"","PeriodicalId":10508,"journal":{"name":"CNS drugs","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Safety of Antipsychotic Medications and Mood Stabilizers During Pregnancy: A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes. 妊娠期抗精神病药物和情绪稳定剂的安全性比较:先天性畸形和产前结果的系统综述和网络 Meta 分析》(A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes.
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1007/s40263-024-01131-x
Enhui Wang, Yilin Liu, Yucheng Wang, Xinyu Han, Yifang Zhou, Lingli Zhang, Yanqing Tang

Background: A network meta-analysis was performed to evaluate the risk of congenital malformations and other prenatal outcomes in fetuses after exposure to antipsychotic medications and mood stabilizers during pregnancy.

Methods: We searched the PubMed, EMBASE, and Cochrane CENTRAL databases up to 15 December 2023, to identify experimental and observational studies comparing antipsychotic and mood stabilizer treatments with control treatments (no exposure). The primary outcome of the study was the incidence of congenital malformations and the secondary outcomes were preterm birth and spontaneous abortion. Additionally, two authors independently assessed the risk of bias in each domain of the included studies using the ROBINS-I tool and evaluated the quality of evidence using the CINeMA rating tool.

Results: The literature search identified 18,334 potential records, and 22 studies involving 3,042,997 pregnant women were ultimately included. Compared with the unexposed group, quetiapine [odds ratio (OR), 1.19; 95% credible interval (CrI), 1.01-1.39], aripiprazole (OR, 1.30; 95% CrI 1.10-1.65), olanzapine (OR, 1.33; 95% CrI 1.11-1.64), risperidone (OR, 1.43; 95% CrI 1.18-1.77), and lithium (OR, 1.61; 95% CrI 1.07-2.30) were associated with a slightly increased risk of congenital malformations. In contrast, lamotrigine (OR, 1.21; 95% CrI 0.86-1.64), ziprasidone (OR, 1.14; 95% CrI 0.73-1.72), and haloperidol (OR, 1.26; 95% CrI 0.90-1.75) did not show significant differences compared with the unexposed group, with narrower credible intervals.

Conclusions: The evidence from this analysis suggests that, overall, quetiapine has the lowest teratogenic risk when used during pregnancy, making it the safer option for pregnant women. Lamotrigine and haloperidol follow closely behind. At the same time, the use of lurasidone and ziprasidone should be approached with caution, and further clinical studies are necessary to better assess their safety.

Systematic review registration: PROSPERO CRD4201811373.

背景:我们进行了一项网络荟萃分析,以评估孕期接触抗精神病药物和情绪稳定剂后胎儿先天性畸形和其他产前结果的风险:我们检索了截至 2023 年 12 月 15 日的 PubMed、EMBASE 和 Cochrane CENTRAL 数据库,以确定比较抗精神病药物和情绪稳定剂治疗与对照治疗(无暴露)的实验性和观察性研究。研究的主要结果是先天性畸形的发生率,次要结果是早产和自然流产。此外,两位作者使用 ROBINS-I 工具独立评估了纳入研究的各个领域的偏倚风险,并使用 CINeMA 评分工具评估了证据质量:文献检索发现了 18,334 条潜在记录,最终纳入了 22 项研究,涉及 3,042,997 名孕妇。与未暴露组相比,喹硫平[几率比(OR),1.19;95% 可信区间(CrI),1.01-1.39]、阿立哌唑(OR,1.30;95% CrI,1.10-1.65)、奥氮平(OR,1.33;95% CrI 1.11-1.64)、利培酮(OR,1.43;95% CrI 1.18-1.77)和锂(OR,1.61;95% CrI 1.07-2.30)与先天性畸形风险略有增加有关。相比之下,拉莫三嗪(OR,1.21;95% CrI 0.86-1.64)、齐拉西酮(OR,1.14;95% CrI 0.73-1.72)和氟哌啶醇(OR,1.26;95% CrI 0.90-1.75)与未暴露组相比没有显著差异,可信区间较窄:本次分析的证据表明,总体而言,喹硫平在妊娠期间的致畸风险最低,因此对孕妇来说是更安全的选择。拉莫三嗪和氟哌啶醇紧随其后。同时,应谨慎使用鲁拉西酮和齐拉西酮,有必要开展进一步的临床研究,以更好地评估其安全性:系统综述注册:PREMCORD4201811373。
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引用次数: 0
TICA-CLOP STUDY: Ticagrelor Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke, a Randomized Controlled Multi-Center Trial. TICA-CLOP研究:Ticagrelor与氯吡格雷治疗急性中度和中重度缺血性卒中的多中心随机对照试验。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-09 DOI: 10.1007/s40263-024-01127-7
Sherihan Rezk Ahmed, Nevine El Nahas, Mohamed Fouad Elsayed Khalil, Ahmed Elbassiouny, Mohamed Ahmed Almoataz, Tarek Youssif Omar, Ahmed Mohamed Ali Daabis, Hossam Mohamed Refat, Ahmed Ahmed Mohamed Kamal Ebied, Asmaa Mohammed Hassan, Diaa Mostafa Atiaa Mohamed, Mohamed Ismaiel, Mohamed G Zeinhom

Background: Many studies evaluated the efficacy and safety of ticagrelor versus clopidogrel in patients with ischemic stroke; none of these trials included North African participants, and all of these trials comprised only participants who experienced transient ischemic attack (TIA) or minor stroke.

Objectives: We compared the efficacy and safety of ticagrelor versus clopidogrel in patients with first-ever noncardioembolic moderate or moderate-to-severe ischemic stroke.

Methods: Our trial involved 900 first-ever noncardioembolic patients with acute ischemic stroke (AIS) who randomly received either loading and maintenance doses of ticagrelor or clopidogrel within the first 24 h of stroke onset.

Results: We involved 900 patients in the intention-to-treat analysis. A total of 39 (8.7%) patients in ticagrelor arm and 62 (13.8%) in clopidogrel arm experienced a new stroke [hazard ratio (HR) 0.46; 95% confidence interval (CI) 0.34-0.83; P value = 0.006]. A total of 57 (12.7%) patients in ticagrelor group and 80 (17.8%) patients in clopidogrel group experienced composite of new stroke, myocardial infarction (MI), or death due to vascular insults (HR 0.51; 95% CI 0.43-0.82; P value = 0.004). Participants who received ticagrelor experienced less frequent unfavorable outcomes. We found no significant variation between our study's two arms concerning the hemorrhagic and non-hemorrhagic complications.

Conclusion: Patients with noncardioembolic moderate or moderate-to-severe ischemic stroke who received ticagrelor within the first 24 h after ischemic stroke had better clinical outcomes based on recurrent stroke rates and unfavorable modified Rankin Scale (mRS) rates compared with those who received clopidogrel. There were no significant variations between ticagrelor and clopidogrel regarding hemorrhagic and non-hemorrhagic complications.

Registration: ClinicalTrials.gov identifier number NCT05553613.

背景:许多研究评估了替卡格雷与氯吡格雷在缺血性卒中患者中的疗效和安全性;这些试验均未纳入北非参与者,而且所有这些试验的参与者均为短暂性脑缺血发作(TIA)或轻微卒中患者:我们比较了替卡格雷与氯吡格雷对首次非心肌栓塞中度或中重度缺血性卒中患者的疗效和安全性:我们的试验涉及 900 名首次非心肌栓塞急性缺血性卒中(AIS)患者,他们在卒中发生后 24 小时内随机接受负荷和维持剂量的替卡格雷或氯吡格雷:我们对 900 名患者进行了意向治疗分析。共有 39 例(8.7%)服用替卡格雷的患者和 62 例(13.8%)服用氯吡格雷的患者发生了新的中风[危险比 (HR) 0.46; 95% 置信区间 (CI) 0.34-0.83; P 值 = 0.006]。替卡格雷组共有 57 例(12.7%)患者,氯吡格雷组共有 80 例(17.8%)患者出现新发中风、心肌梗死或因血管损伤死亡的复合情况(HR 0.51;95% CI 0.43-0.82;P 值 = 0.004)。接受替卡格雷治疗的参试者发生不良后果的频率较低。我们发现,在出血和非出血并发症方面,研究的两个臂之间没有明显差异:结论:与接受氯吡格雷治疗的患者相比,在缺血性脑卒中发生后 24 小时内接受替卡格雷治疗的非心肌栓塞中度或中重度缺血性脑卒中患者,根据脑卒中复发率和改良Rankin量表(mRS)不良率计算,临床预后更好。在出血性和非出血性并发症方面,替卡格雷和氯吡格雷之间没有明显差异:注册:ClinicalTrials.gov 识别号 NCT05553613。
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引用次数: 0
Glutamatergic Modulators for Major Depression from Theory to Clinical Use. 治疗重度抑郁症的谷氨酸能调节剂从理论到临床应用。
IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI: 10.1007/s40263-024-01114-y
Roger S McIntyre, Rakesh Jain

Major depressive disorder (MDD) is a chronic, burdensome, highly prevalent disease that is characterized by depressed mood and anhedonia. MDD is especially burdensome as approved monoamine antidepressant treatments have weeks-long delays before clinical benefit and low remission rates. In the past 2 decades, a promising target emerged to improve patient outcomes in depression treatment: glutamatergic signaling. This narrative review provides a high-level overview of glutamate signaling in synaptogenesis and neural plasticity and the implications of glutamate dysregulation in depression. Based on this preclinical evidence implicating glutamate in depression and the rapid improvement of depression with ketamine treatment in a proof-of-concept trial, a range of N-methyl-D-aspartate (NMDA)-targeted therapies have been investigated. While an array of treatments has been investigated in registered phase 2 or 3 clinical trials, the development of most of these agents has been discontinued. Multiple glutamate-targeted antidepressants are actively in development, and two are approved. Nasal administration of esketamine (Spravato®) was approved by the US Food and Drug Administration (FDA) in 2019 to treat adults with treatment-resistant depression and in 2020 for adults with MDD with acute suicidal ideation or behavior. Oral combination dextromethorphan-bupropion (AXS-05, Auvelity® extended-release tablet) was FDA approved in 2022 for the treatment of MDD in adults. These approvals bolster the importance of glutamate in depression and represent an exciting breakthrough in contemporary psychiatry, providing new avenues of treatment for patients as first-line therapy or with either poor response or unacceptable side effects to monoaminergic antidepressants.

重度抑郁症(MDD)是一种以情绪低落和情感淡漠为特征的慢性、负担沉重的高发疾病。由于已获批准的单胺抗抑郁剂治疗在临床获益前会有长达数周的延迟,且缓解率低,因此重度抑郁症的负担尤为沉重。在过去的二十年中,出现了一个有希望改善抑郁症治疗效果的靶点:谷氨酸能信号传导。这篇叙述性综述高度概括了谷氨酸信号在突触生成和神经可塑性中的作用,以及谷氨酸失调对抑郁症的影响。基于谷氨酸与抑郁症有关的临床前证据,以及氯胺酮治疗在概念验证试验中对抑郁症的迅速改善,一系列以 N-甲基-D-天冬氨酸(NMDA)为靶点的疗法已被研究。虽然在已登记的 2 期或 3 期临床试验中对一系列疗法进行了研究,但其中大多数药物的研发工作已经停止。多种谷氨酸靶向抗抑郁药物正在积极研发中,其中两种已获得批准。美国食品和药物管理局(FDA)于2019年批准鼻腔给药艾司卡胺(Spravato®)用于治疗成人耐药性抑郁症,并于2020年批准其用于治疗伴有急性自杀意念或行为的成人多发性抑郁症。右美沙芬-安非他酮口服复方制剂(AXS-05,Auvelity® 缓释片)于 2022 年获得 FDA 批准,用于治疗成人 MDD。这些批准加强了谷氨酸在抑郁症中的重要性,是当代精神病学中令人兴奋的突破,为作为一线治疗或对单胺类抗抑郁药反应不佳或有不可接受的副作用的患者提供了新的治疗途径。
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