Expert Opinion on Pharmacotherapy最新文献

Introduction: Brain metastases represent a major cause of morbidity and mortality in cancer patients and are challenging to manage due to the protective blood-brain barrier and the aggressive nature of intracranial disease. Angiogenesis, particularly mediated by vascular endothelial growth factor (VEGF) and integrin pathways, plays a critical role in the growth and progression of brain metastases. Inhibiting angiogenesis has emerged as a therapeutic strategy to control tumor progression, reduce edema, and improve clinical outcomes.

Area covered: This review summarizes the biological mechanisms underpinning angiogenesis in brain metastases, with a focus on VEGF and integrins as therapeutic targets. The role of bevacizumab, a monoclonal anti-VEGF antibody, is discussed in detail, particularly its established use in managing radiation necrosis. The review further explores FDA-approved angiogenesis inhibitors, emerging therapies targeting alternative pathways such as angiopoietin-2 and integrins, and the latest clinical trials assessing their efficacy. Combination strategies, particularly with immune checkpoint inhibitors and radiation, are highlighted as promising avenues for improving intracranial disease control.

Expert opinion: Anti-angiogenic therapies, while already well integrated into the management of radiation necrosis, are poised to expand into active treatment paradigms for brain metastases. Future advances are likely to focus on biomarker-driven patient selection, novel drug delivery technologies, and rational combination regimens. Angiogenesis inhibitors are expected to become a standard component of multimodal treatment approaches, moving beyond symptomatic control toward improving progression-free and overall survival in patients with brain metastases.

Introduction: Immune thrombocytopenia (ITP) treatment goals vary by gestational period. In the first 8 months of gestation, treatment is not indicated unless platelets are <20,000/uL or for clinically significant bleeding. The platelet goal is >70,000/uL for epidural administration and delivery.

Areas covered: We review the data on efficacy and safety of medications used to treat ITP in pregnancy, including the associated risks and optimal timing of administration of the first-line treatments of corticosteroids and/or intravenous immunoglobulin (IVIG). We also discuss second-line treatment options.

Expert opinion: The differential diagnosis of thrombocytopenia in pregnancy is broad. When ITP is the most likely diagnosis, the decision to treat versus monitor only will depend on the platelet nadir, gestational week, and signs of clinically significant bleeding. Many patients will not require treatment in the first 8 months of gestation. Starting at 34-36 weeks gestation, enhanced therapies may be required to prepare for labor and delivery. We recommend starting with prednisone 20-60 mg daily. If prednisone alone is insufficient, IVIG 1-2 g/kg should be added. Combined prednisone and IVIG will yield the desired platelet response in ~ 80% of cases. Approach to second-line therapy is complicated, but we consider TPO receptor agonist use in the peripartum period.

Introduction: Enmetazobactam, taniborbactam, and zidebactam are novel β-lactamase inhibitors that have been combined with cefepime in an effort to overcome common and emerging mechanisms of antimicrobial resistance.

Areas covered: We performed a literature review of articles written in English using MEDLINE, PUBMED, and EMBASE, using the search terms 'Cefepime-enmetazobactam,' 'cefepime-taniborbactam,' and 'Cefepime-zidebactam' between January 2015 and May 2025. This review summarizes the in vitro, animal, and clinical data for cefepime-enmetazobactam, cefepime-taniborbactam, and cefepime-zidebactam to forecast their potential role in clinical practice.

Expert opinion: Cefepime-enmetazobactam and cefepime-taniborbactam are among the newest additions to an expanding antibiotic armamentarium; however, their precise role in clinical practice remains to be defined given that their in vitro activity overlaps with current treatment options. On balance, the in vitro activity of cefepime-zidebactam fills critical gaps for the most challenging Gram-negative pathogens, including those that harbor metallo-β-lactamases with or without mutations in penicillin-binding proteins. For each of these agents, clinical data and real-world evidence generation are needed to better define their therapeutic niche, potential for resistance selection, and potential benefits compared to currently available antibiotics.

Introduction: A key challenge in managing schizophrenia is ensuring adequate adherence to antipsychotic treatment. Long-acting injectable (LAI) antipsychotics play a crucial role in improving adherence, yet certain clinical needs remain unmet, including a rapid symptom control and satisfactory efficacy/tolerability balance.

Areas covered: Main pharmacokinetics and pharmacodynamics properties as well as the effectiveness and safety profile of risperidone in situ microparticles (ISM®) are described. The aim of this narrative review is to explore how this innovative risperidone LAI formulation may be utilized in schizophrenia treatment.

Expert opinion: Risperidone ISM® employs innovative in situ microimplant technology for biphasic drug release, achieving immediate and sustained therapeutic plasma concentrations without the need for oral supplementation or loading doses. Indeed, it is characterized by a fast-acting release, reaching active risperidone moiety levels within 12 hours that are comparable to steady-state concentrations observed with oral risperidone (mean concentration of 38.63 ng/mL). The resulting plasma levels ensure consistent dopamine D₂ receptor occupancy above 65% over the full 28-day dosing cycle - an established benchmark for antipsychotic efficacy. In the short-term, risperidone ISM® enables a rapid and sustained symptoms reduction among adults with acute schizophrenia exacerbations, eliminating the need for initial loading doses or concurrent oral supplementation.

Introduction: Obesity is a pandemic and a key driver of type 2 diabetes mellitus, heart disease, and healthcare spending. Incretin drug therapy prescribing for obesity has dramatically increased in recent years, necessitating researchers and clinicians to rapidly update their understanding of and approach to obesity management.

Areas covered: We assembled a multi-disciplinary team of experts to identify and complete a narrative review of the relevant literature regarding behavioral interventions, nutrition, physical activity, incretin drug therapy for weight loss, and the management of incretin drug adverse effects.

Expert opinion: Incretin drug therapy can produce significant weight loss in properly selected individuals. However, many do not continue therapy indefinitely. To maximize the benefits of incretin therapy, individuals should receive behavioral support to increase their physical activity, the healthfulness of their diet, protein intake, awareness of food triggers, and ultimately their probability of short-term weight loss and long-term weight maintenance regardless of the long-term use of incretin therapy.

Introduction: Ulcerative colitis (UC) often requires immunomodulatory therapies that balance efficacy with safety. Among biologics, vedolizumab and ustekinumab have emerged as alternatives to anti-tumor necrosis factor alpha (TNF-α) agents. We aim to address the incidence of specific infectious adverse events associated with these agents outside clinical trials using a real-world database.

Methods: We conducted a retrospective cohort study using the TriNetX database. Three cohorts were defined as adult patients with UC, each treated with one of the following: ustekinumab, anti-TNFα agents, or vedolizumab. We used propensity score matching to balance groups. Outcomes included a new infection diagnosis.

Results: Participants receiving ustekinumab demonstrated a significantly lower risk of several infections compared to those on anti-TNFα therapy, including pneumonia, urinary tract infection, cellulitis, Clostridioides difficile infection, infectious diarrhea, and sepsis. Compared to vedolizumab, ustekinumab was associated with a reduced risk of cellulitis and Clostridioides difficile infection.

Discussion: Our findings demonstrate that ustekinumab is associated with a significantly lower risk of several infections. However, there is a less prominent difference in infectious risk when compared to vedolizumab. These results suggest that ustekinumab may offer a safer alternative, compared to anti-TNFα agents and possibly to vedolizumab, particularly those at higher risk of infections.

Introduction: Drug development for epilepsy, the most frequent chronic neurologic childhood condition, faces fundamental challenges. One of these is the concept of children as 'therapeutic orphans' and the resulting pediatric requirements of the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Developing new antiseizure medications (ASMs) is expensive. Public coffers and reimbursement institutions are increasingly struggling with fundings. Commercial drug developers are progressively skeptical about the risks of developing new ASMs, which makes a critical review of pediatric requirements even more important.

Areas covered: This narrative review traces the roots of pediatric drug development in epilepsy and analyses the current FDA and EMA regulatory frameworks and incentives that shape ASMs approval for children. PubMed, EMBASE, Scopus and Google Scholar were searched for publications using combinations of terms related to 'pediatric epilepsy,' 'antiseizure medications,' 'regulatory frameworks' and 'pediatric drug development.' Official FDA, EMA websites and documents were also screened.

Expert opinion: A more focused and science-driven approach, less influenced by nonscientific factors and emerging conflicts of interest, could help accelerate the development of innovative treatments for epilepsy. Optimizing incentives to align research with true pediatric needs, especially those targeting childhood-specific syndromes and age-appropriate pharmacology, is essential.

Introduction: Cannabis use disorder (CUD) is a growing global health concern, with limited pharmacological treatments currently available despite increasing prevalence and legalization trends.

Areas covered: This review explores the landscape of pharmacotherapies for CUD, including both repurposed agents and emerging investigational compounds. We summarize findings from recent systematic reviews and meta-analyses, with attention to mechanisms of action and clinical relevance. Agents discussed include gabapentin, N-acetylcysteine, synthetic cannabinoids, fatty acid amide hydrolase (FAAH) inhibitors, orexin receptor antagonists, and psychedelics. A narrative approach was used, informed by targeted searches of PubMed, Google Scholar, and clinical trial registries from 2000 to 2025, focusing on human studies, randomized trials, and meta-analyses relevant to pharmacologic management of CUD.

Expert opinion: The pharmacologic treatment of CUD is in its early stages, with no approved agents and modest efficacy demonstrated to date. Novel compounds targeting endocannabinoid tone and motivational circuits show promise, but significant research is still needed. Future progress depends on better integration with behavioral care, trial stratification by clinical phenotype, and increased investment in translational research to move beyond withdrawal symptom management toward sustained recovery.

Introduction: There have been recent major advances in the management and treatment of mantle cell lymphoma (MCL). This uncommon subtype of mature B-cell lymphoma has a heterogeneous clinical course, including a spectrum of indolent and aggressive disease. While historically regarded as an incurable disease with a poor long-term prognosis, recent developments have improved outcomes.

Areas covered: The incorporation of targeted treatments, such as covalent Bruton's tyrosine kinase inhibitors (cBTKi), with or without chemo-immunotherapy in the upfront treatment setting is supported by recent clinical trials indicating encouraging efficacy and safety. Measurable residual disease (MRD) testing is emerging as a potent tool in guiding treatment decision and improving outcomes while minimizing toxicities. Therapies utilized in relapsed/refractory disease, such as BCL2 inhibitors as well as immune-leveraging therapies, including T-cell engaging antibodies and chimeric antigen receptor (CAR) T-cells therapy, are being evaluated in upfront settings.

Expert opinion: This review will discuss recent advances in the upfront management of this challenging disease as well as a suggested treatment algorithm considering both availability and unavailability of first-line cBTKi. The incorporation of cBTKi to chemo-immunotherapy regimens appears effective and safe. However, patients with high-risk disease may require novel therapeutic approaches due to suboptimal outcomes with chemo-immunotherapy.

Background: PCOS is an endocrine disorder affecting women of reproductive-aged group. It has multiple manifestations, including metabolic, reproductive, and psychological domains. Among PCOS patients, pharmaceutical management remains a primary approach to its treatment, particularly when lifestyle changes do not yield improvements.

Objective: This study aims to highlight trends in global research concerning PCOS and its pharmacological treatment within the last decade using bibliometric analysis.

Methods: A bibliometric analysis was conducted for the 2015-2024 timeframe using Web of Science database. Search queries were designed for PCOS as well as its pharmacological treatment options. Data analysis was performed through visualization of collaborations, research trends, etc. in VOS viewer.

Results: 2607 publications qualified for inclusion criteria. The most frequently treated topics were combined oral contraceptives, metformin, letrozole, and inositols. China is the leading contributor toward publication volume, while the U.S.A. was the most cited and had the strongest links. Influence appeared to stem from Monash University, and Legro RS was the most influential the most impactful author.

Conclusion: The study reveals global trends in PCOS pharmacotherapy, with a growing focus on metabolic and molecular aspects. Key contributors and emerging therapies highlight the expanding scope and future potential of PCOS treatment research.