Expert Opinion on Pharmacotherapy最新文献

Introduction: Updated guidelines for heart failure with reduced ejection fraction (HFrEF) and acute decompensation have improved outcomes, but ongoing efforts are focused on uncovering new evidence and developing novel therapies. This review examines the limitations of current treatments and the potential impact of emerging therapies.

Areas covered: A literature search focused on studies investigating drugs for HFrEF. We review recent clinical trials and emerging therapies to assess evidence strength, explore guideline updates, and identify strategies to optimize patient outcomes.

Expert opinion: The HFrEF treatment landscape is rapidly evolving, with advances in therapies like sodium/glucose cotransporter inhibitors and sacubitril-valsartan. Though managing acute decompensated heart failure remains challenging, recent trials suggest improvements in diuretic strategies and anti-inflammatory treatments. Ongoing research is essential for validating these therapies and incorporating them into standard practice.

Introduction: Antidepressants and menopause are risk factors which are independently associated with an increased risk of fractures. This review aims to investigate the risk of fragility fractures in women aged 40 and older and prescribed antidepressants.

Methods: A literature search was conducted using PubMed, Ovid Embase, Ovid PsychINFO, Web of Science, and Scopus from inception to 1 June 2024. Relevant citations were identified and screened against our inclusion/exclusion criteria. The study population comprised women over 40 years. The risk of fragility fractures was compared between users and non-users of antidepressants. Risk of bias assessment was carried out using the ROBINS-I tool. A meta-analysis of cohort studies was performed to assess fracture risk associated with prescribing of any antidepressant agents, and SSRIs specifically.

Results: Of the 3,676 articles retrieved, five observational studies were found eligible for inclusion (n = 1,240,354). In a meta-analysis of 4 studies, an increased risk of fractures in women was associated with the prescribing of antidepressants (HR = 1.62, 95% CI: 1.15-2.28; I² = 96.50%) and SSRIs in particular (HR = 1.36, 95% CI: 1.20-1.55; I² = 40.32%).

Conclusions: Findings from this review suggest that prescribing of antidepressants is associated with an increased risk of fractures in women aged 40 and older. Substantial heterogeneity between studies may have affected the results of the meta-analysis.

Introduction: Nontuberculous mycobacteria (NTM) represent a group of microorganisms comprising more than 190 species. NTM infections have increased recently, and their treatment is a major challenge because to their resistance to conventional treatments. This review focuses on innovative strategies aimed at eradicating NTM biofilms, a critical factor in their resistance. Important areas addressed include biofilm formation mechanisms, current therapeutic challenges, and novel treatment approaches. The main objective is to compile and analyze information on these emerging strategies, identifying pivotal research directions and recent advancements.

Areas covered: A review of the scientific literature was conducted to identify emerging novel therapies for the treatment of NTM infections and to explore potential synergies with existing treatments.

Expert opinion: Experts highlights a limited understanding of optimal treatment regimens, often supported by insufficient scientific evidence. Current therapies are typically prolonged, involve multiple antibiotics with adverse effects, and frequently do not achieve patient cure. Certain species are even considered virtually impossible to eradicate. A thorough understanding of these new approaches is imperative for improving patients outcomes. This review provides a robust foundation for developing of more effective antibacterial strategies, which are essential because of the increasing incidence of NTM infections and the limitations of existing therapies.

Introduction: Proliferative lupus nephritis is a common and severe complication of systemic lupus erythematosus. Affected patients are at an increased risk of developing chronic kidney disease, end-stage kidney disease, and extra-renal comorbidities. In recent years, the prognosis for patients with proliferative lupus nephritis has improved thanks to advancements in management regimens. Despite these advances, lupus nephritis continues to present therapeutic complexities and unmet needs.

Areas covered: Research was conducted across major databases to identify the most relevant articles pertaining to immune-mediating and immunosuppressive therapies in lupus nephritis.

Expert opinion: The prognosis for patients with proliferative lupus nephritis remains severe. Some drugs used in this disease may be unable to control activity, and most of them have a low therapeutic index and may cause severe and life-threatening side effects. Nonetheless, better management of traditional drugs and the introduction of novel therapies have improved renal prognosis and reduced local and systemic adverse events in patients with proliferative lupus nephritis.

Background: Polycystic ovarian syndrome (PCOS) has been a common metabolic and endocrinal disorder, prevalent amongst women belonging to the reproductive age group. The aim of this systematic review was to assess the safety and efficacy profile of sodium-glucose cotransporter 2 (SGLT2) inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, and Licogliflozin) for the treatment of women suffering from PCOS.

Methods: A literature search in PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted for randomized clinical trials of SGLT-2 inhibitors in PCOS patients by applying predetermined inclusion and exclusion criteria. The articles in English language were included.

Results: Four randomized controlled trials including 146 subjects were included in the review. The clinical studies indicated a significant decrease in the levels of total testosterone, free androgen index, total body fat, homeostasis model assessment-estimated insulin resistance (HOMA-IR), body mass index (BMI), dehydroepiandrosterone sulfate (DHEAS) and fasting plasma glucose (FPG). However, no significant difference was reported in levels of sex hormone-binding globulin (SHBG). Overall, there was improvement in metabolic and endocrine profiles, suggesting a potentially beneficial impact of SGLT2 inhibitors in the management of PCOS.

Conclusion: There is a requirement for large extensive clinical trials to demonstrate the efficacy of SGLT-2 inhibitors in PCOS patients.

Introduction: Intra-abdominal infections are becoming increasingly common and can lead to significant morbidity and mortality. The incidence of these infections due to resistant gram-negative organisms is also increasing. Given this resistance, new antibiotic combinations are being developed, often utilizing older antibiotics and newer β-lactamase inhibitors. Aztreonam/avibactam (ATM-AVI) is one of the combination antibiotics, which combines aztreonam, a monobactam, with avibactam, a broad-spectrum β-lactamase inhibitor for the treatment of complicated intra-abdominal infections in combination with metronidazole.

Areas covered: In this drug evaluation manuscript, we provide an overview of intra-abdominal infections and an overview of currently available antimicrobial agents used to treat these infections. ATM-AVI is introduced, including chemistry, pharmacodynamics, pharmacokinetics and clinical studies of this compound.

Expert opinion: There are limited treatment options for complicated intra-abdominal infections due to resistant gram-negative organisms, especially those with metallo-β-lactamases. One treatment option for these infections is ATM-AVI, which was recently approved in Europe, in addition to metronidazole. These bacteria are difficult to treat, and this new compound is a safe and effective option for empiric treatment in places with a high incidence of infections due to these bacteria, and also treatment for infections when these resistant bacteria are isolated in culture.

Introduction: Cholesteryl ester transfer protein (CETP) plays an important role in lipid metabolism. Early interest in the development of CETP inhibitors proved to be disappointing. Recent interest has focused on the potential for CETP inhibition to reduce cardiovascular risk by lowering levels of low-density lipoprotein cholesterol (LDL-C).

Areas covered: The data suggesting that low CETP activity may associate with lower levels of cardiovascular risk and early experience with CETP inhibitors focused on raising HDL-C levels. More recent data that suggests that any potential to reduce cardiovascular risk by inhibition of CETP is more likely to result from lowering levels of atherogenic lipid parameters. The development of obicetrapib, a potent CETP inhibitor, with robust lowering of apoB and LDL-C, will be summarized as a potential approach to the prevention of cardiovascular disease.

Expert opinion: Obicetrapib is a potent CETP inhibitor, with a demonstrated ability to lower levels of apoB and LDL-C as monotherapy and in addition to high intensity statin therapy. The ultimate impact of obicetrapib on cardiovascular events will be evaluated by ongoing clinical trials.

Introduction: Decongestants are commonly used drugs in clinical practice, and they can relieve nasal congestion caused by factors like influenza, rhinitis, and acute upper respiratory tract infection.

Areas covered: In this article, we review the research outcomes about decongestants, which aim to provide beneficial information that can guide the clinical application of decongestants for clinicians.

Expert opinion: Although the use of nasal decongestants is increasingly limited, caution rather than prohibition is now advocated. Scientific and accurate use of nasal decongestants can achieve satisfactory clinical effectiveness on nasal congestion, and it is not easy to produce adverse reactions. Patients with severe nasal congestion may use nasal decongestants solely or in combination with nasal corticosteroids or nasal antihistamines to exert a synergistic effect. The concentration, dose, frequency, and time of nasal decongestants determine whether drug-induced rhinitis will occur. Additionally, we recommend patients not to buy nasal sprays with unknown ingredients on the internet or in pharmacy, so as to avoid the risk of rhinitis medicamentosa. For patients with rhinitis medicamentosa, the use of nasal decongestants should be stopped immediately. However, more evidence is still needed to standardize the clinical use of nasal decongestants.

Introduction: Gastroesophageal reflux disease (GERD) is a chronic disease of the esophagus characterized by the regurgitation of stomach contents into the esophagus, causing troublesome symptoms and/or complications. Among patients with GERD, around 30% of patients have visible mucosal damage, while 70% have normal esophageal mucosa. Accordingly, the optimal pharmacological treatment of GERD should address different disease manifestations, including symptoms, the mucosal damage when present, and possible chronic complications, including strictures, Barrett's esophagus, and esophageal adenocarcinoma.

Areas covered: Available medical treatments for GERD include proton pump inhibitors (PPIs), potassium-competitive acid blockers (PCABs), histamine receptor antagonists (H2-RAs), prokinetics, and mucosal protectants, such as alginates, hyaluronic acid/chondroitin-sulfate, and poliprotect. Each compound has its own advantages and disadvantages, and knowledge of expected benefits and tips for their use is paramount for the success of treatment. In addition, the appropriateness of indications for initiating treatment is also crucial to achieve positive results when managing GERD patients.

Expert opinion: PPIs, PCABs, H2-RAs, prokinetics, and mucosal protectants can all be used in patients with GERD, but careful assessment of patients' characteristics as well as advantages and disadvantages of each therapeutic compound is essential to ensure successful treatment of GERD.