Expert Opinion on Pharmacotherapy最新文献

Introduction: Alpha-1 adrenergic receptor antagonists (α1-ARAs) are used in the well-established treatment for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Since BPH and erectile dysfunction (ED) are commonly concomitant conditions, the importance of addressing the potential role of α1-ARA in patients with ED is rising.

Methods: We systemically reviewed literature for studies that assessed erectile function (EF) indices in relation to α1-ARA use. All types of comparisons were included.

Results: Out of 1915 records, 21 articles have been included. All the articles suffered high risk of bias. α1-ARA showed a significant improvement in EF in comparison to baseline and placebo. Some α1-ARA are more erectogenic than others. Combined therapy with phosphodiesterase-5 inhibitors improved EF better than either alone. Factors like associated lower urinary symptoms, dose, and duration of therapy modify α1-ARA effects on EF.

Conclusion: Αlpha1-ARAs have a potential role in improving EF in subjective and objective scales. However, the available evidence is extracted from studies on patients with other indications for α1-ARAs, particularly BPH-related LUTS. Further investigations should target patients with ED only to precisely identify their clinical utility.

Introduction: Chorea is a motor manifestation of Huntington's disease (HD), which can lead to decreased functional independence and falls. Even though multiple classes of medications have been used to treat this symptom, only the vesicular monoamine transporter 2 (VMAT2) inhibitors tetrabenazine, deutetrabenazine, and valbenazine have been approved by the FDA for this indication.

Areas covered: This article reviews the pharmacological properties, clinical efficacy, safety, and tolerability of valbenazine in the treatment of chorea in HD. Key considerations in the concomitant use of VMAT2 inhibitors with other medications are discussed, particularly considerations specific to valbenazine use plus medications often used to treat neuropsychiatric symptoms in HD.

Expert opinion: Valbenazine effectively addresses chorea. Its selectivity avoids VMAT1-related side effects and tardive dyskinesia and may result in less off-target side effects such as parkinsonism, behavioral changes, and akathisia. The cost of this medication could be a barrier to access, even for those with insurance, due to high co-pay fees. Head-to-head clinical trials are needed to compare valbenazine's efficacy with the other approved drugs for chorea in HD.

Introduction: Type 1 diabetes is a unique autoimmune attack on the β cell of the pancreatic islet resulting in progressive destruction of these cells and as a result the ability of the body to maintain insulin production. The consequences of insulin deficiency are very severe, and the disease was fatal prior to the ability to extract insulin from animal pancreas in 1921. We review progress in the treatment of childhood type 1 diabetes over the past 100 years.

Areas covered: We used PubMed and standard search engines to search for the evolution of diagnosis and treatment of type 1 diabetes.

Expert opinion: Insulin replacement proved lifesaving for children afflicted with type 1 diabetes. However, it was observed that these children suffered from microvascular and large vessel disease. The Diabetes Control and Complications Trial (DCCT) with its extension Epidemiology of Diabetes Interventions and Complications Trial (EDIC) proved that control of blood glucose as close to normal as possible could prevent these diabetes-related conditions. Many formuations of insulin with varying onset and duration of action have been developed; yet normalization of glucose levels is difficult due to hypoglycemic events. There is continued progress toward that goal.

Introduction: Overactive bladder (OAB) is a prevalent disorder with a significant impact on quality of life. The pathophysiology of OAB is multifactorial and the majority of patients will require treatment with multiple therapies across the course of their disease. First-line treatments include bladder retraining, fluid advice and pelvic floor muscle training. Following this, patients may be offered treatment with anticholinergic and β₃ agonist medications. Anticholinergics are known to have high rates of discontinuation due to side effects and there are concerns regarding anticholinergic load and its impact on cognitive function in older adults.

Areas covered: This paper aims to discuss the current and emerging treatment options available for patients who suffer from OAB.

Expert opinion: The management of OAB in the clinical setting remains challenging. The goal of newer pharmacotherapies in OAB would be treatment that provides long-term symptomatic relief with minimal side effects and an improved quality of life. The future of OAB research is promising and should consider the implications of the gut-bladder axis, regenerative medicine, biomarkers and the role of digital health.

Introduction: Kidney failure is a life-limiting condition that profoundly impacts an individual's quality of life. The significant medication burden on patients required to manage the comorbidities and complications of kidney failure can have implications for patient-reported and clinical outcomes.

Methods: This work systematically reviewed methods used to assess medication regimen complexity amongst adults with kidney failure, the associated patient-reported and clinical outcomes, and the effectiveness of interventions to address regimen complexity. A comprehensive search of PubMed, Embase, Web of Science, and Scopus covering all relevant literature up until November 2023 was performed.

Results: The findings of this review suggest that patients with kidney failure are prescribed complex medication regimens, which have implications for both clinical and patient-related outcomes. A significant link was found between regimen complexity and poor health outcomes, particularly in the dialysis-dependent patient population. These outcomes included poor quality of life, medication adherence, frailty, hospitalization, and mortality. Interventions to improve medication regimen complexity included de-prescribing tools and pharmacist-led medication management services.

Conclusion: Future research should consider well-designed prospective longitudinal studies that develop more comprehensive and standardized definitions of medication regimen complexity. Additionally, multifaceted interventions are needed to address the complex medication regimen to improve outcomes in patients with kidney failure.

Introduction: Substance use disorders (SUDs) are a public health issue, with only some having FDA-approved indicated treatments and these having high attrition. Consequently, there has been interest in novel interventions (e.g. psychedelics that target 5-HT2A receptors) with some promising results. In this narrative review, we aim to focus on the role of the 5-HT2A receptors on the effectiveness of the treatment of SUDs.

Areas covered: We evaluated the clinical evidence of the treatment of SUDs with non-psychedelic medications with a primary affinity for the 5-HT2A receptor.

Expert opinion: The reviewed literature showed some positive effects on craving and abstinence but, overall, results were mixed. Comparison of this work with work on psychedelic agents suggests that mixed results are not unique to non-psychedelic agents. Both psychedelic and non-psychedelic drugs with 5-HT2A affinity are not exclusively selective for 5-HT2A receptors. The observation that most agents reviewed are 5-HT2A receptor antagonists instead of agonists and that psychedelics (typically 5-HT2A receptor agonists) may have more homogenous positive results gives more support to 5-HT2A receptor agonists as a promising group for treating SUDs. Mechanisms may target a common denominator across SUDs (e.g. chronic hypodopaminergic states).

Introduction: Complicated urinary tract infections (cUTIs) represent a significant clinical challenge due to their association with sepsis, high morbidity and mortality, and an increased risk of recurrence and chronic infection. Effective management requires prompt, targeted interventions.

Areas covered: This review highlights the importance of early, targeted antibiotic therapy based on local resistance profiles, patient-specific factors, and pharmacokinetic/pharmacodynamic considerations. We examined emerging and existing antibiotics, including beta-lactams, fluoroquinolones, aminoglycosides, and beta-lactamase inhibitor combinations, which show potential against multidrug-resistant organisms (MDRO) linked to cUTI. Additionally, we propose revisiting the broad definition of cUTI to promote a more pragmatic approach that minimizes unnecessary antibiotic use and hospitalization.

Expert opinion: Current evidence underscores the need for antimicrobial stewardship, precise diagnostics, and innovative therapies to address cUTI while mitigating antimicrobial resistance. A targeted, patient-centered approach is essential to optimize outcomes and reduce the burden of resistant infections.