Pub Date : 2024-11-06DOI: 10.1080/14656566.2024.2427335
Elisa Marabotto, Francesco Calabrese, Andrea Pasta, Pierfrancesco Visaggi, Nicola de Bortoli, Amir Mari, Salvatore Tolone, Matteo Ghisa, Luisa Bertin, Vincenzo Savarino, Edoardo Vincenzo Savarino
Introduction: Gastroesophageal reflux disease (GERD) is a common debilitating chronic disease presenting in two main forms based on esophageal mucosal appearance, the erosive reflux disease (ERD) and the non-erosive reflux disease (NERD). Acid secretion is a key factor in the disease pathogenesis and management. Potent acid-suppressant drugs have been manufactured since the mid of 1970s, initially with histamine-H2-receptors antagonists, and later, inhibitors of the proton pump (H+-K+-ATPase). More recently, potassium-competitive acid blockers (P-CABs), particularly Vonoprazan, have been introduced. Vonoprazan has shown high efficacy and safety profiles and exhibits several advantages that allow to overcome shortcomings of proton pump inhibitors (PPIs).
Areas covered: In this review, we provide an updated summary of Vonoprazan pharmacodynamics and its role in clinical practice for the management of erosive esophagitis and GERD related heartburn. Moreover, we discuss characteristics of Vonoprazan that allow to bypass some limitations of the older PPIs.
Expert opinion: Long-term safety and efficacy of Vonoprazan have already been demonstrated for the induction and maintenance of ERD, preventing nocturnal acid breakthrough, reducing reflux symptoms in non-responder to standard therapy. Ongoing and future studies are expected to further elucidate its long-term benefits and potential applications in other acid-related disorders.
{"title":"Evaluating Vonoprazan for the treatment of erosive GERD and heartburn associated with GERD in adults.","authors":"Elisa Marabotto, Francesco Calabrese, Andrea Pasta, Pierfrancesco Visaggi, Nicola de Bortoli, Amir Mari, Salvatore Tolone, Matteo Ghisa, Luisa Bertin, Vincenzo Savarino, Edoardo Vincenzo Savarino","doi":"10.1080/14656566.2024.2427335","DOIUrl":"https://doi.org/10.1080/14656566.2024.2427335","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal reflux disease (GERD) is a common debilitating chronic disease presenting in two main forms based on esophageal mucosal appearance, the erosive reflux disease (ERD) and the non-erosive reflux disease (NERD). Acid secretion is a key factor in the disease pathogenesis and management. Potent acid-suppressant drugs have been manufactured since the mid of 1970s, initially with histamine-H2-receptors antagonists, and later, inhibitors of the proton pump (H+-K+-ATPase). More recently, potassium-competitive acid blockers (P-CABs), particularly Vonoprazan, have been introduced. Vonoprazan has shown high efficacy and safety profiles and exhibits several advantages that allow to overcome shortcomings of proton pump inhibitors (PPIs).</p><p><strong>Areas covered: </strong>In this review, we provide an updated summary of Vonoprazan pharmacodynamics and its role in clinical practice for the management of erosive esophagitis and GERD related heartburn. Moreover, we discuss characteristics of Vonoprazan that allow to bypass some limitations of the older PPIs.</p><p><strong>Expert opinion: </strong>Long-term safety and efficacy of Vonoprazan have already been demonstrated for the induction and maintenance of ERD, preventing nocturnal acid breakthrough, reducing reflux symptoms in non-responder to standard therapy. Ongoing and future studies are expected to further elucidate its long-term benefits and potential applications in other acid-related disorders.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1080/14656566.2024.2426680
Giovanni Catalano, Odysseas P Chatzipanagiotou, Jun Kawashima, Timothy M Pawlik
Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has been introduced as a superior term to describe steatosis on a background of metabolic dysregulation and is slated to become the leading cause of HCC worldwide, as the incidence of metabolic comorbidities is increasing. As such, MASLD has evolved into an important public health issue, potentially leading to higher rates of liver mortality and end-stage liver disease. To this end, understanding the association between MASLD and HCC may allow for the identification of better interventions and novel therapeutic strategies.
Areas covered: The authors provide a review of current knowledge on HCC development among patients with MASLD, with insights into molecular pathways and current and future therapeutic strategies.
Expert opinion: MASLD has a strong association with the risk of HCC development, as metabolic comorbidities induce dysregulation in molecular pathways, leading to insulin-resistance, oxidative stress, and chronic inflammation, thus causing progression to cirrhosis and eventually to HCC. Therapeutic strategies focused on reducing diabetes-associated complications, as well as the prevalence of obesity and smoking can improve patient outcomes and reduce HCC incidence. Future studies on the molecular background of metabolic alterations may help devise new therapeutic approaches aiming to improve the current management of MASLD-HCC.
{"title":"Metabolic-associated steatotic liver disease and hepatocellular carcinoma.","authors":"Giovanni Catalano, Odysseas P Chatzipanagiotou, Jun Kawashima, Timothy M Pawlik","doi":"10.1080/14656566.2024.2426680","DOIUrl":"10.1080/14656566.2024.2426680","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has been introduced as a superior term to describe steatosis on a background of metabolic dysregulation and is slated to become the leading cause of HCC worldwide, as the incidence of metabolic comorbidities is increasing. As such, MASLD has evolved into an important public health issue, potentially leading to higher rates of liver mortality and end-stage liver disease. To this end, understanding the association between MASLD and HCC may allow for the identification of better interventions and novel therapeutic strategies.</p><p><strong>Areas covered: </strong>The authors provide a review of current knowledge on HCC development among patients with MASLD, with insights into molecular pathways and current and future therapeutic strategies.</p><p><strong>Expert opinion: </strong>MASLD has a strong association with the risk of HCC development, as metabolic comorbidities induce dysregulation in molecular pathways, leading to insulin-resistance, oxidative stress, and chronic inflammation, thus causing progression to cirrhosis and eventually to HCC. Therapeutic strategies focused on reducing diabetes-associated complications, as well as the prevalence of obesity and smoking can improve patient outcomes and reduce HCC incidence. Future studies on the molecular background of metabolic alterations may help devise new therapeutic approaches aiming to improve the current management of MASLD-HCC.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1080/14656566.2024.2427338
Udaya S Tantry, Richard C Becker, Sahib Singh, Lekshminarayan Raghavakurup, Eliano Navarese, Kevin P Bliden, Paul A Gurbel
Introduction: Recent data question the use of aspirin as a bedrock of antiplatelet therapy in patients with arterial diseases. There are controversies regarding the efficacy of aspirin therapy with respect to specific demographic characteristics, dose and formulations, benefit in primary prevention, and duration in secondary prevention. Importantly, to balance the ischemic benefits and the risk of excessive bleeding following a coronary event, recent studies have investigated strategies to discontinue aspirin therapy and continue with P2Y12 receptor inhibitor monotherapy. But the precise time when to discontinue aspirin is still unresolved.
Areas covered: Evidence from recent studies evaluating the role of aspirin in primary and secondary prevention studies were collected from a selective literature search. In this review, the authors discuss current recommendations, large scale studies of aspirin therapy, controversies, and potential future opportunities for aspirin therapy.
Expert opinion: With the new evidence showing lower bleeding risk with aspirin free strategies in both primary and secondary prevention studies, the role of aspirin is being revaluated with P2Y12 receptor inhibitor monotherapy. The potential benefit of novel aspirin formulations and alternative delivery methods, such as inhaled aspirin, are undergoing much needed investigation with the goal of optimizing care for a wide range of patients.
{"title":"Reassessing the role of aspirin in patients with coronary artery disease.","authors":"Udaya S Tantry, Richard C Becker, Sahib Singh, Lekshminarayan Raghavakurup, Eliano Navarese, Kevin P Bliden, Paul A Gurbel","doi":"10.1080/14656566.2024.2427338","DOIUrl":"https://doi.org/10.1080/14656566.2024.2427338","url":null,"abstract":"<p><strong>Introduction: </strong>Recent data question the use of aspirin as a bedrock of antiplatelet therapy in patients with arterial diseases. There are controversies regarding the efficacy of aspirin therapy with respect to specific demographic characteristics, dose and formulations, benefit in primary prevention, and duration in secondary prevention. Importantly, to balance the ischemic benefits and the risk of excessive bleeding following a coronary event, recent studies have investigated strategies to discontinue aspirin therapy and continue with P2Y<sub>12</sub> receptor inhibitor monotherapy. But the precise time when to discontinue aspirin is still unresolved.</p><p><strong>Areas covered: </strong>Evidence from recent studies evaluating the role of aspirin in primary and secondary prevention studies were collected from a selective literature search. In this review, the authors discuss current recommendations, large scale studies of aspirin therapy, controversies, and potential future opportunities for aspirin therapy.</p><p><strong>Expert opinion: </strong>With the new evidence showing lower bleeding risk with aspirin free strategies in both primary and secondary prevention studies, the role of aspirin is being revaluated with P2Y<sub>12</sub> receptor inhibitor monotherapy. The potential benefit of novel aspirin formulations and alternative delivery methods, such as inhaled aspirin, are undergoing much needed investigation with the goal of optimizing care for a wide range of patients.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1080/14656566.2024.2424316
Millie C Kirchberg, Claire Pinson, Guido K W Frank
Introduction: Anorexia nervosa (AN) has one of the highest mortality rates of all mental illnesses. No approved pharmacological treatments exist for AN, but novel neurobiological targets show promise.
Areas covered: Studies show that in individuals with AN, there are alterations in brain neurotransmitter signaling, alongside associated mental rigidity and comorbid anxiety and depression. Available and new therapies could be used to improve alterations in neurobiology and behavior. This narrative review serves as a review of previously published literature assessing the efficacy of traditional pharmacotherapy in treating AN while also exploring novel treatments, including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition.
Expert opinion: If best practice psychotherapeutic interventions have failed, we recommend a neuroscience and brain research-based medication approach that targets dopamine neurotransmitter receptors to enhance cognitive flexibility and illness insight while reducing dread and avoidance toward food. It is furthermore essential to recognize and treat comorbid conditions such as anxiety, depression, or obsessive-compulsive disorder as they interfere with recovery, and typically do not resolve even with successful AN treatment. Novel strategies have the promise to show efficacy in improving mood and reducing specific AN psychopathology with hopes to be used in clinical practice soon.
简介神经性厌食症(AN)是死亡率最高的精神疾病之一。目前尚无针对神经性厌食症的经批准的药物治疗方法,但新的神经生物学靶点显示出治疗前景:研究表明,神经性厌食症患者的大脑神经递质信号发生改变,同时伴有精神僵化、合并焦虑和抑郁。现有疗法和新疗法可用于改善神经生物学和行为学的改变。这篇叙述性综述回顾了之前发表的文献,评估了传统药物疗法治疗自闭症的疗效,同时还探讨了新型疗法,包括解离性麻醉剂、迷幻剂、大麻素、激素、神经类固醇和生酮营养:如果最佳心理治疗干预无效,我们建议采用以神经科学和脑科学研究为基础的药物治疗方法,以多巴胺神经递质受体为靶点,增强认知灵活性和疾病洞察力,同时减少对食物的恐惧和回避。此外,认识并治疗焦虑症、抑郁症或强迫症等合并症也很重要,因为这些疾病会影响患者的康复,而且即使成功治疗了自闭症,这些疾病通常也不会消失。新策略有望在改善情绪和减少特定 AN 精神病理学方面显示出疗效,并有望很快应用于临床实践。
{"title":"Pharmacotherapeutic strategies for the treatment of anorexia nervosa - novel targets to break a vicious cycle.","authors":"Millie C Kirchberg, Claire Pinson, Guido K W Frank","doi":"10.1080/14656566.2024.2424316","DOIUrl":"10.1080/14656566.2024.2424316","url":null,"abstract":"<p><strong>Introduction: </strong>Anorexia nervosa (AN) has one of the highest mortality rates of all mental illnesses. No approved pharmacological treatments exist for AN, but novel neurobiological targets show promise.</p><p><strong>Areas covered: </strong>Studies show that in individuals with AN, there are alterations in brain neurotransmitter signaling, alongside associated mental rigidity and comorbid anxiety and depression. Available and new therapies could be used to improve alterations in neurobiology and behavior. This narrative review serves as a review of previously published literature assessing the efficacy of traditional pharmacotherapy in treating AN while also exploring novel treatments, including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition.</p><p><strong>Expert opinion: </strong>If best practice psychotherapeutic interventions have failed, we recommend a neuroscience and brain research-based medication approach that targets dopamine neurotransmitter receptors to enhance cognitive flexibility and illness insight while reducing dread and avoidance toward food. It is furthermore essential to recognize and treat comorbid conditions such as anxiety, depression, or obsessive-compulsive disorder as they interfere with recovery, and typically do not resolve even with successful AN treatment. Novel strategies have the promise to show efficacy in improving mood and reducing specific AN psychopathology with hopes to be used in clinical practice soon.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1080/14656566.2024.2422547
Giovanni Corona, Giulia Rastrelli, Clotilde Sparano, Linda Vignozzi, Alessandra Sforza, Mario Maggi
Introduction: Erectile dysfunction (ED) is a neglected complication in patients with pre-diabetes or diabetes mellitus (DM).
Areas covered: A summary and review of the role of standard ED treatment and the contribution of lifestyle modification and hypoglycemic drugs.
Expert opinion: Oral phosphodiesterase type 5 inhibitors (PDE5i) represent the first-line therapy even in patients with DM. Testosterone replacement therapy (TRT) is mandatory in all hypogonadal (total testosterone < 12 nmol/l) subjects. Alprostadil and/or combined approaches can be considered when PED5i with or without TRT fail. The glycometabolic optimization through lifestyle modification and the use of hypoglycemic drugs represents a crucial step, even for ED treatment. Considering the strong association between ED and forthcoming cardiovascular diseases, the selection of glucagon-like peptide type 1 analogues or sodium glucose cotransporter-2 inhibitors seems to represent the best option due to their long-term effect on chronic complication prevention. Metformin can be considered a possible alternative in less complicated subjects. Penile prostheses (PP) can be offered when all other options are not effective, but the patients should be informed that poor glycometabolic control can increase the risk of PP infection.
{"title":"Pharmacotherapeutic strategies for the management of erectile dysfunction in patients with diabetes and pre-diabetes.","authors":"Giovanni Corona, Giulia Rastrelli, Clotilde Sparano, Linda Vignozzi, Alessandra Sforza, Mario Maggi","doi":"10.1080/14656566.2024.2422547","DOIUrl":"https://doi.org/10.1080/14656566.2024.2422547","url":null,"abstract":"<p><strong>Introduction: </strong>Erectile dysfunction (ED) is a neglected complication in patients with pre-diabetes or diabetes mellitus (DM).</p><p><strong>Areas covered: </strong>A summary and review of the role of standard ED treatment and the contribution of lifestyle modification and hypoglycemic drugs.</p><p><strong>Expert opinion: </strong>Oral phosphodiesterase type 5 inhibitors (PDE5i) represent the first-line therapy even in patients with DM. Testosterone replacement therapy (TRT) is mandatory in all hypogonadal (total testosterone < 12 nmol/l) subjects. Alprostadil and/or combined approaches can be considered when PED5i with or without TRT fail. The glycometabolic optimization through lifestyle modification and the use of hypoglycemic drugs represents a crucial step, even for ED treatment. Considering the strong association between ED and forthcoming cardiovascular diseases, the selection of glucagon-like peptide type 1 analogues or sodium glucose cotransporter-2 inhibitors seems to represent the best option due to their long-term effect on chronic complication prevention. Metformin can be considered a possible alternative in less complicated subjects. Penile prostheses (PP) can be offered when all other options are not effective, but the patients should be informed that poor glycometabolic control can increase the risk of PP infection.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1080/14656566.2024.2422548
Dilan Gençel, Nejla Nur Erbil, Şeniz Demiryürek, Abdullah Tuncay Demiryürek
Introduction: Heterotopic ossification (HO), acquired or hereditary, is a diverse pathological condition defined by the production of extraskeletal bone in muscles, soft tissues, and connective tissues. Acquired HO is relatively prevalent and develops mostly in response to trauma, although its etiology is unknown. Genetic forms provide insight into the pathobiological mechanisms of this disorder. Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary form of HO that can have a significant impact on affected individuals. FOP steadily weakens affected subjects and increases their risk of death.
Areas covered: The U.S. Food and Drug Administration has recently approved the retinoid palovarotene as the first compound to treat heterotopic ossification in patients with FOP. This review provides a comprehensive overview of current and potential future pharmacotherapeutic options and their modes of action. The online databases PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using the terms 'heterotopic ossification' and 'fibrodysplasia ossificans progressiva' or synonyms, with a special focus over the last 5 years of publications.
Expert opinion: Approval of palovarotene, as the first retinoid indicated for reduction in the volume of new HO, may revolutionize the therapeutic landscape. However, long-term safety and efficacy data for palovarotene are currently lacking.
{"title":"Current and emerging treatment modalities for fibrodysplasia ossificans progressiva.","authors":"Dilan Gençel, Nejla Nur Erbil, Şeniz Demiryürek, Abdullah Tuncay Demiryürek","doi":"10.1080/14656566.2024.2422548","DOIUrl":"10.1080/14656566.2024.2422548","url":null,"abstract":"<p><strong>Introduction: </strong>Heterotopic ossification (HO), acquired or hereditary, is a diverse pathological condition defined by the production of extraskeletal bone in muscles, soft tissues, and connective tissues. Acquired HO is relatively prevalent and develops mostly in response to trauma, although its etiology is unknown. Genetic forms provide insight into the pathobiological mechanisms of this disorder. Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary form of HO that can have a significant impact on affected individuals. FOP steadily weakens affected subjects and increases their risk of death.</p><p><strong>Areas covered: </strong>The U.S. Food and Drug Administration has recently approved the retinoid palovarotene as the first compound to treat heterotopic ossification in patients with FOP. This review provides a comprehensive overview of current and potential future pharmacotherapeutic options and their modes of action. The online databases PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using the terms 'heterotopic ossification' and 'fibrodysplasia ossificans progressiva' or synonyms, with a special focus over the last 5 years of publications.</p><p><strong>Expert opinion: </strong>Approval of palovarotene, as the first retinoid indicated for reduction in the volume of new HO, may revolutionize the therapeutic landscape. However, long-term safety and efficacy data for palovarotene are currently lacking.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1080/14656566.2024.2421323
Pragnya R Donthineni, Wade Munger, Anat Galor
{"title":"Investigating recent advances in pharmacotherapy for acute and chronic ocular pain post-cataract surgery.","authors":"Pragnya R Donthineni, Wade Munger, Anat Galor","doi":"10.1080/14656566.2024.2421323","DOIUrl":"10.1080/14656566.2024.2421323","url":null,"abstract":"","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1080/14656566.2024.2418414
Guglielmo Fibbi, Ryosuke Sato, Mirela Vatic, Frederik Pascal Genreith, Stephan von Haehling
Introduction: Heart failure (HF) is a global health challenge that requires a multidisciplinary approach. Despite recent advances in pharmacological and interventional therapy, morbidity and mortality in these patients remain high. For this reason, and because of its interplay with other cardiovascular and non-cardiovascular diseases, HF represents a major area of research, with new trials being published every year and international guidelines constantly updated.
Areas covered: The authors review the current status and possible future developments in HF pharmacotherapy.
Expert opinion: The treatment of HF has made significant advances in recent years, and the current recommendations are based on large outcome trials. This has led to significant reductions in both mortality and morbidity, but the death rate remains unacceptably high. In this context, a patient-centered approach that considers comorbidities and specific clinical scenarios when dosing HF medication is essential. Prevention of hospital admissions for cardiac decompensation is of utmost importance in patients with HF as is the enablement of activities of daily living, an endpoint which has only recently been incorporated into major HF trials.
{"title":"Pharmacological management of heart failure: a patient-centered approach.","authors":"Guglielmo Fibbi, Ryosuke Sato, Mirela Vatic, Frederik Pascal Genreith, Stephan von Haehling","doi":"10.1080/14656566.2024.2418414","DOIUrl":"https://doi.org/10.1080/14656566.2024.2418414","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) is a global health challenge that requires a multidisciplinary approach. Despite recent advances in pharmacological and interventional therapy, morbidity and mortality in these patients remain high. For this reason, and because of its interplay with other cardiovascular and non-cardiovascular diseases, HF represents a major area of research, with new trials being published every year and international guidelines constantly updated.</p><p><strong>Areas covered: </strong>The authors review the current status and possible future developments in HF pharmacotherapy.</p><p><strong>Expert opinion: </strong>The treatment of HF has made significant advances in recent years, and the current recommendations are based on large outcome trials. This has led to significant reductions in both mortality and morbidity, but the death rate remains unacceptably high. In this context, a patient-centered approach that considers comorbidities and specific clinical scenarios when dosing HF medication is essential. Prevention of hospital admissions for cardiac decompensation is of utmost importance in patients with HF as is the enablement of activities of daily living, an endpoint which has only recently been incorporated into major HF trials.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1080/14656566.2024.2418983
Mengru Zhang, Alyn H Morice
Introduction: Chronic cough has increasingly been recognized as a distinct clinical entity that affects a significant portion of the global population. Despite advancements in understanding its pathophysiology, treatment options remain limited. Opioid analgesics have long been used for cough and some have proven clear antitussive potential. However, these have yet to be approved by regulatory authorities for the treatment of chronic cough. Several novel synthetic opioid modulators that demonstrated antitussive effects in early-stage studies also failed to translate into clinical practice.
Areas covered: This mini review aims to summarize the implications of opioid receptors in the development of cough medicines and highlight recent advances of opioid analgesics in cough trials. PUB MED/CINAHL/Web of Science/Scopus were searched (September 2024).
Expert opinion: Our understanding of the precise sites of action and the involvement of peripheral opioid receptors in cough remains limited. Despite these gaps in knowledge, opioids remain a viable option for some patients until more novel effective treatments are available. Due to the frequent opioid side effects, new opioids derivatives with improved properties are needed. The development of tailored or biased delta-opioid receptor ligands and mixed agonists of opioid receptor-like 1/mu receptors may offer hope for new opioid-based drug discovery for chronic cough.
导言:人们日益认识到,慢性咳嗽是一种独特的临床症状,影响着全球相当一部分人口。尽管在了解其病理生理学方面取得了进展,但治疗方案仍然有限。长期以来,阿片类镇痛药一直被用于治疗咳嗽,其中一些已被证明具有明显的止咳潜力。然而,这些药物尚未被监管机构批准用于治疗慢性咳嗽。一些新型合成阿片调节剂在早期研究中显示出止咳效果,但也未能应用于临床实践:本微型综述旨在总结阿片受体在止咳药研发中的意义,并重点介绍阿片类镇痛药在止咳试验中的最新进展。检索了 PUB MED/CINAHL/Web of Science/Scopus(2024 年 9 月):我们对咳嗽的确切作用部位和外周阿片受体参与情况的了解仍然有限。尽管存在这些知识空白,但在出现更多新型有效治疗方法之前,阿片类药物仍是一些患者的可行选择。由于阿片类药物经常出现副作用,因此需要性能更好的新型阿片类药物衍生物。开发定制的或偏向δ-阿片受体配体以及阿片受体样1/mu受体的混合激动剂可能会为基于阿片的慢性咳嗽新药研发带来希望。
{"title":"Current and emerging opioids for the treatment of chronic cough: a mini review.","authors":"Mengru Zhang, Alyn H Morice","doi":"10.1080/14656566.2024.2418983","DOIUrl":"https://doi.org/10.1080/14656566.2024.2418983","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic cough has increasingly been recognized as a distinct clinical entity that affects a significant portion of the global population. Despite advancements in understanding its pathophysiology, treatment options remain limited. Opioid analgesics have long been used for cough and some have proven clear antitussive potential. However, these have yet to be approved by regulatory authorities for the treatment of chronic cough. Several novel synthetic opioid modulators that demonstrated antitussive effects in early-stage studies also failed to translate into clinical practice.</p><p><strong>Areas covered: </strong>This mini review aims to summarize the implications of opioid receptors in the development of cough medicines and highlight recent advances of opioid analgesics in cough trials. PUB MED/CINAHL/Web of Science/Scopus were searched (September 2024).</p><p><strong>Expert opinion: </strong>Our understanding of the precise sites of action and the involvement of peripheral opioid receptors in cough remains limited. Despite these gaps in knowledge, opioids remain a viable option for some patients until more novel effective treatments are available. Due to the frequent opioid side effects, new opioids derivatives with improved properties are needed. The development of tailored or biased delta-opioid receptor ligands and mixed agonists of opioid receptor-like 1/mu receptors may offer hope for new opioid-based drug discovery for chronic cough.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Sepsis remains a major global public health challenge. The host's response in sepsis involves both an exaggerated inflammatory reaction and immunosuppressive mechanisms. A better understanding of this response has shed light on the failure of anti-inflammatory therapies administered under the 'one size fits all' approach during the last decades.
Areas covered: To date, patients' management has moved toward a comprehensive precision medicine approach that aims to personalize immunotherapy, whether anti-inflammatory or immunostimulatory. Large Prospective interventional randomized controlled trials validating this approach are about to start. A crucial prerequisite for these studies is to stratify patients based on biomarkers that will help defining the patients' immuno-inflammatory trajectory.
Expert opinion: Some biomarkers are already available in routine clinical care, while improvements are anticipated through the standardized use of transcriptomics and other multi-omics technologies in this field. With these precautions in mind, it is reasonable to anticipate improvement in outcomes in sepsis.
{"title":"Shadows and lights in sepsis immunotherapy.","authors":"Guillaume Monneret, Muzhda Haem Rahimi, Anne-Claire Lukaszewicz, Fabienne Venet, Morgane Gossez","doi":"10.1080/14656566.2024.2418987","DOIUrl":"https://doi.org/10.1080/14656566.2024.2418987","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis remains a major global public health challenge. The host's response in sepsis involves both an exaggerated inflammatory reaction and immunosuppressive mechanisms. A better understanding of this response has shed light on the failure of anti-inflammatory therapies administered under the 'one size fits all' approach during the last decades.</p><p><strong>Areas covered: </strong>To date, patients' management has moved toward a comprehensive precision medicine approach that aims to personalize immunotherapy, whether anti-inflammatory or immunostimulatory. Large Prospective interventional randomized controlled trials validating this approach are about to start. A crucial prerequisite for these studies is to stratify patients based on biomarkers that will help defining the patients' immuno-inflammatory trajectory.</p><p><strong>Expert opinion: </strong>Some biomarkers are already available in routine clinical care, while improvements are anticipated through the standardized use of transcriptomics and other multi-omics technologies in this field. With these precautions in mind, it is reasonable to anticipate improvement in outcomes in sepsis.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}