Drugs in Context最新文献

The global rise in obesity and its associated health risks has driven the need for more effective pharmacological treatments. Glucagon receptor (GCGR)-based multi-agonist drugs are emerging as promising treatments for obesity, with several in advanced stages of clinical development. Agents like mazdutide, pemvidutide, survodutide and retatrutide have demonstrated the ability to trigger significant weight loss in earlier phase trials, often surpassing the amount of weight loss obtained with existing therapies. Their potential to address obesity-related comorbidities, including type 2 diabetes mellitus and cardiovascular disease, positions them as important additions to future obesity treatment guidelines. As these GCGR-based multi-agonists advance through clinical trials, their impact on obesity management may be substantial, particularly for patients who have not achieved success with current medications or lifestyle interventions. Some are also being evaluated for cardiovascular outcomes, highlighting their relevance in populations at high risk with overweight and obesity. Key considerations as these drugs move forward in development to eventual approval include cost, access and long-term safety. This article is part of the Real-world evidence on the use of GLP1 receptor agonists Special Issue: https://www.drugsincontext.com/special_issues/real-world-evidence-on-the-use-of-glp1-receptor-agonists.

Background: Dispensing prescription-only medications without a valid prescription poses significant public health risks, including inappropriate drug use, adverse drug reactions and medication dependence. Narcotics and psychotropic drugs are particularly vulnerable to misuse. Despite this, limited data exist on the dispensing practices of these medications at community drug retail outlets in Ethiopia. This study aimed to assess the extent and factors of non-prescription dispensing of narcotic and psychotropic medications at community drug retail outlets in Ethiopia.

Methods: An observational cross-sectional study was conducted using the simulated client method from June 1, 2023, to September 30, 2023, in Debre Markos town, Ethiopia. Three trained volunteer pharmacy professionals acted as simulated clients. A validated simulated client approach was used to request medications through three different scenarios: symptom-based (depression), direct request by name and request by presenting a medication package.

Results: A total of 109 requests were made by the simulated clients at 38 community drug retail outlets during three rounds of observations. The rates of non-prescription dispensing were 28.9% for depression simulation, 60.5% for direct name requests and 81.6% for package-based requests. A total of nine types of narcotic and psychotropic medications were dispensed without prescription, the most common of which were amitriptyline, followed by tramadol, carbamazepine, pethidine and haloperidol.

Conclusion: This study revealed a high prevalence of non-prescription dispensing of narcotic and psychotropic medications, particularly in response to assertive client requests. Urgent regulatory measures are needed to ensure adherence to prescription-only policies, especially for frequently dispensed drugs such as amitriptyline, tramadol and chlorpromazine.

Background: Acne vulgaris is one of the most common dermatological illnesses affecting people worldwide. In Pakistan, approximately 9.4% of the population and between 5% and 16% of young adults are affected by acne vulgaris. Conventional therapies (topical benzoyl peroxide, retinoids, antibiotics and oral isotretinoin) are effective but limited by antibiotic resistance and side effects. Curcumin (a natural anti-inflammatory/antimicrobial from turmeric) and serratiopeptidase (a proteolytic enzyme with anti-inflammatory, anti-oedematous and antibiofilm properties) each show promise in acne treatment. This article evaluates the efficacy of a combined oral curcumin plus serratiopeptidase formulation as an adjunct to inflammatory acne therapy.

Methods: Fifty individuals with mild-to-moderate symptoms of inflammatory acne participated in this quasi-experimental study. They were allocated to standard therapy alone (topical regimen: benzoyl peroxide 5% and adapalene 0.1% gel; oral doxycycline 100 mg once daily) or standard therapy plus a daily curcumin (500 mg) + serratiopeptidase (10 mg) supplement (adjunctive therapy). Acne severity was assessed using a visual analogue scale (VAS) and lesion improvement scale at baseline, 1 week and 2 weeks of treatment. Data were analysed with parametric tests after normalization (log transformation), with significance set at p<0.05.

Results: Baseline characteristics were similar between groups (mean age: 23 years; 66% female). Both groups showed significant improvement in mean VAS (from 7.5 at baseline to 3.1 at 2 weeks; p<0.001). The adjunctive therapy group achieved a markedly higher complete/near-complete improvement rate by week 2 (84% versus 28%; p<0.001). No serious adverse events occurred.

Conclusion: Curcumin plus serratiopeptidase, as an adjunct to standard therapy significantly, accelerated the resolution of inflammatory acne lesions within 2 weeks, with excellent tolerability. This novel combination targets inflammatory pathways and could reduce reliance on prolonged antibiotics. Larger, longer-term studies are recommended to confirm these findings and evaluate effects on relapse and scarring.

This case report explores the potential of 0.5% indomethacin eye drops (Indo0.5) in preventing the progression of epiretinal membrane traction. A 72-year-old patient with progressive vitreomacular traction was treated with Indo0.5, leading to a significant decrease in intraretinal cyst within 8 months, complete resorption after 16 months and full restoration of the retinal profile after 22 months. A mini literature review highlights the anti-inflammatory effects of indomethacin for various conditions affecting the anterior segment and suggests that the 0.5% concentration may also be effective in managing retinal inflammation. Indo0.5 could be a non-invasive option for slowing epiretinal membrane traction progression, supporting further research to optimize treatment strategies.

The combination of the immune-checkpoint inhibitor pembrolizumab plus lenvatinib, an angiogenesis inhibitor targeting VEGFR/FGFR, has been approved as standard second-line treatment for patients with recurrent or metastatic endometrial cancer progressed to first-line platinum-based chemotherapy regardless of mismatch repair status and based on the results of the KEYNOTE-775 trial. This article reports on the case of a middle-aged woman with advanced microsatellite stable, p53-mutant endometrial cancer who achieved a meaningful and sustained partial response, with good tolerability, to second-line treatment with pembrolizumab plus lenvatinib. This favourable outcome was compared with efficacy and toxicity data available in the current literature. Pembrolizumab plus lenvatinib can significantly prolong progression-free survival, especially in patients with a negative prognostic molecular profile, who at most can benefit from combining different therapeutic strategies. The heterogeneous treatment-related adverse events landscape should not discourage therapy prescription because most adverse events are easily manageable following simple precautions. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Immunotherapy has revolutionized the treatment landscape for solid tumours. Here, we describe the case of a 69-year-old woman with advanced endometrial cancer (EC) who achieved prolonged disease control with immunotherapy. The patient was diagnosed with stage IIIC EC in February 2020 and was treated with carboplatin and paclitaxel, followed by radiotherapy. Relapses occurred in February 2021 (treated with doxorubicin and palliative radiotherapy) and July 2022 (treated with a carboplatin rechallenge). Pembrolizumab and lenvatinib were started in November 2022. Although the initial scan showed progressive disease, restaging 2 months later showed stable disease, which was maintained on pembrolizumab and lenvatinib until progression in October 2024. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Endometrial cancer (EC) is the most common gynaecological malignancy in developed countries, with advanced-stage disease posing significant therapeutic challenges. Standard treatments, including surgery, radiotherapy and chemotherapy, have limited efficacy in recurrent or metastatic cases, necessitating novel therapeutic approaches. Recent molecular classifications of EC have identified subtypes with distinct prognostic and therapeutic implications, particularly those with high immunogenicity. Immunotherapy, specifically immune-checkpoint inhibitors targeting PD-1/PD-L1, has transformed EC treatment. The combination of pembrolizumab, an anti-PD-1 monoclonal antibody, and lenvatinib, a tyrosine kinase inhibitor (TKI), has demonstrated superior efficacy over chemotherapy in the pivotal KEYNOTE-775 trial, significantly improving progression-free and overall survival in advanced EC. Additionally, dostarlimab has shown promise as a monotherapy for mismatch repair-deficient EC, expanding treatment options. This special series in Drugs in Context explores these advancements through clinical case studies, highlighting real-world applications of immunotherapy and TKIs. Cases illustrate treatment responses, challenges in managing toxicities and the evolving role of molecular profiling in personalizing therapy. As research progresses, integrating immunotherapy and TKIs into routine practice is expected to improve outcomes for patients with advanced EC, offering new hope in a previously limited therapeutic landscape. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Advanced endometrial carcinoma (EC) is typically associated with poor prognosis. However, recent advances have revolutionized therapeutic strategies. In patients with microsatellite stable (MSS) advanced EC, pembrolizumab plus lenvatinib have significantly improved overall survival, progression-free survival and response rate compared to standard chemotherapy. We describe the case of a 63-year-old woman with advanced endometrioid adenocarcinoma exhibiting mismatch repair proficiency (pMMR) and MSS who started treatment with pembrolizumab and lenvatinib after failing multiple lines of therapy. The patient had a favourable response, with mild side effects, and continues to receive treatment. Our experience supports pembrolizumab plus lenvatinib as a promising therapeutic option for patients with advanced recurrent EC with pMMR/MSS. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Until recently, treatment options for patients with recurrent or metastatic endometrial cancer (EC) were limited. First-line treatment is usually based on carboplatin and paclitaxel and there was no standard second-line therapy following platinum failure. However, the introduction of immunotherapy has expanded both first-line and later-line options for EC and made determination of mismatch repair status essential. We describe the case of a 56-year-old woman with deficient mismatch repair/microsatellite instability EC who did not respond to first-line treatment with carboplatin and paclitaxel but had a high response to subsequent immunotherapy with dostarlimab. There was initial pseudoprogression of one target lesion but marked improvement in quality of life. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that occurs more frequently in children but can also manifest in adults. Approximately 15-20% of children are affected worldwide. Persistent AD may be present in approximately 50% of patients during childhood. Despite the pivotal studies, there are not enough real-life studies using dupilumab, especially in Latin American countries. This study was performed in Brazil and is essential for evaluating this population. The objective of the study was to understand the real-life efficacy and safety of using dupilumab in patients with moderate or severe AD.

Methods: Observational, descriptive study based on the biweekly evaluation of 100 patients using the immunobiological dupilumab in an infusion clinic for 16 consecutive weeks. Data collection was conducted from June 2020 to March 2022. To evaluate each sequential SCORing Atopic Dermatitis (SCORAD) value, a repeated measures analysis of variance was performed, with a value of p<0.0001.

Results: There was a significant decrease in SCORAD values from the second week of treatment. In 16 weeks, 80% of patients achieved SCORAD-50 and 37% achieved SCORAD-75. Regarding adverse effects, 22% of patients had conjunctivitis, 11% had facial erythema, 1% had herpes simplex and 1% had hypochromia at the application site. Regarding efficacy, the results showed a reduction in SCORAD value by 67.4% in 16 weeks, 72% of patients achieved SCORAD <25, that is, mild atopic dermatitis.

Conclusion: This study identified that dupilumab was effective in real life, even outside of the controlled environments of pivotal studies. Additionally, despite conjunctivitis being a common adverse event, no patient required treatment discontinuation.