LCZ696 : a new paradigm for the treatment of heart failure?

INTRODUCTION

Heart failure (HF) represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology. Currently, blockade of the renin-angiotensin-aldosterone system (RAAS) is the cornerstone of treatment; however, the combination of RAAS blockade with inhibition of neprilysin (NEP), an enzyme that degrades natriuretic peptides, has recently emerged as a potentially superior treatment strategy.

AREAS COVERED

Following the results of the recent Phase III Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure clinical trial in patients with chronic HF with reduced ejection fraction (HF-REF), this review focuses on LCZ696 , a first-in-class angiotensin receptor NEP inhibitor. This drug consists of a supramolecular complex containing the angiotensin receptor inhibitor valsartan in combination with the NEP inhibitor prodrug, AHU377. Following oral administration, the LCZ696 complex dissociates and the NEP inhibitor component is metabolized to the active form (LBQ657). Aspects of the trial that might be relevant to clinical practice are also discussed.

EXPERT OPINION

Speculation that LCZ696 will pass the scrutiny of regulatory agencies for HF-REF appears to be justified, and it is likely to become a core therapeutic component in the near future. Replication of the eligibility criteria and titration protocol used in the PARADIGM-HF trial would be valuable in clinical practice and may minimize the risk of adverse events. Although long-term data remain to be generated, the promising results regarding hypertension are likely to expedite acceptance of the drug for HF-REF.

Stability enhancement of organic photovoltaic devices utilizing partially reduced graphene oxide as the hole transport layer: nanoscale insight into structural/interfacial properties and aging effects

A powerful insight into the structural and interfacial properties of post-fabricated bulk heterojunction (BHJ) organic photovoltaic (OPV) devices, utilizing partially reduced graphene oxide as the hole transport layer, is reported.

Invivo absorption behaviour of theophylline from starch-methyl methacrylate matrix tablets in beagle dogs

This study evaluates in vivo the drug absorption profiles from potato starch-methyl methacrylate matrices(*) using theophylline as a model drug. Healthy beagle dogs under fasting conditions were used for in vivo studies and plasma samples were analyzed by a fluorescence polarization immunoassay analysis (FPIA method). Non-compartmental and compartmental (population approach) analysis was performed to determine the pharmacokinetic parameters. The principle of superposition was applied to predict multiple dose plasma concentrations from experimental single dose data. An in vitro-in vivo correlation (IVIVC) was also assessed. The sustained absorption kinetics of theophylline from these formulations was demonstrated by comparison with two commercially available oral sustained-release theophylline products (Theo-Dur(®) and Theolair(®)). A one-compartment model with first order kinetics without lag-time best describes the absorption/disposition of theophylline from the formulations. Results revealed a theophylline absorption rate in the order FD-HSMMA≥Theo-Dur(®)≥OD-CSMMA>Theolair(®)≥FD-CSMMA. On the basis of simulated plasma theophylline levels, a twice daily dosage (every 12h) with the FD-CSMMA tablets should be recommended. A Level C IVIVC was found between the in vitrot50% and the in vivo AUC/D, although further optimization of the in vitro dissolution test would be needed to adequately correlate with in vivo data.

U300, a novel long-acting insulin formulation

INTRODUCTION

Insulin glargine (100 U/ml; U100) was the first long-acting basal insulin analog to be introduced into clinical practice and it remains the most widely used. Although U100 is an effective and safe treatment, research is ongoing to optimize the time-action profile. The focus of this review is insulin glargine [rDNA origin] injection 300 U/ml (U300), a novel formulation that contains a higher concentration of insulin than U100.

AREAS COVERED

The clinical efficacy and safety of U300 in patients with type 1 and type 2 diabetes mellitus are discussed, with an emphasis on recently released data from the Phase III EDITION clinical trials.

EXPERT OPINION

The higher concentration of insulin in U300 results in a distinct pharmacokinetic and pharmacodynamic profile. U300 has a longer duration of action than U100 and plasma insulin exposure is less variable. Both insulin formulations exhibit a similar efficacy and safety profile, but importantly, U300 is associated with less body weight gain and a lower incidence of hypoglycaemic events.

Spatially-resolved in-situ structural study of organic electronic devices with nanoscale resolution: the plasmonic photovoltaic case study

A novel high spatial resolution synchrotron X-ray diffraction stratigraphy technique has been applied in-situ to an integrated plasmonic nanoparticle-based organic photovoltaic device. This original approach allows for the disclosure of structure-property relations linking large scale organic devices to length scales of local nano/hetero structures and interfaces between the different components.

Where do we stand with IPF treatment?

Despite receiving ‘weak no’ recommendations in the updated guidelines on treating patients with Idiopathic Pulmonary Fibrosis (IPF), two key treatment options are pirfenidone and N-acetylcysteine (NAC), and both are used in clinical practice. The efficacy of pirfenidone is supported by a number of Phase III trials as well as a Cochrane meta-analysis. Tolerability data are also provided by clinical trials and a long-term extension phase of these studies. Pirfenidone is approved in Europe for the treatment of patients with mild-to-moderate IPF. NAC-based therapy has no such approval, but is commonly used to treat patients. A Phase III trial suggested some benefit of the NAC, prednisone and azathioprine regimen for IPF patients, but the study had many limitations. A further study to investigate this regimen, compared with a placebo alone arm, was recently stopped due to increased mortality in the triple-therapy arm. Discussion of these data and recent findings highlight the importance of a further update to the existing guidelines, so that IPF specialists can provide the most up-to-date advice and treatment to patients in clinical practice.

Bent perfect crystals as X-ray focusing polychromators in symmetric Laue geometry

The focusing properties of cylindrically bent crystals in symmetric Laue geometry are discussed using the formalism of Fresnel diffraction and the analytical solution of the Takagi-Taupin equations for a point source on the entrance surface. The existence of a focal shift in the dynamical focusing effect is pointed out and discussed. The present theoretical framework is applied to experiments performed at the energy-dispersive X-ray absorption spectroscopy beamline of the European Synchrotron Radiation Facility concerning the position and the size of the focal spot obtained from a polychromatic source at a large distance from the bent crystal.

[Employment of disabled people regarding Italian Law "68/99": Florence's ASL N. 10 experience]

The reform of mandatory employment in Italy, performed by the national Law 68/99, represented a crucial step for the assertion of the right to work for disabled people. The aim of our experience is to obtain information about health and safety conditions of disabled people employed in targeted workplaces and about the issues for that workers keep or lose their job, possibly in order to take actions on workplaces and to improve job conditions for all other workers also. In this paper we used data regarding targeted employments of disabled people, collected during the year 2008 in the Province of Florence.