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Choi D, Stewart AP, Bhat S. Ozanimod: A First-in-Class Sphingosine 1-Phosphate Receptor Modulator for the Treatment of Ulcerative Colitis. Ann Pharmacother 2021; 56:592-599. [PMID: 34423657 DOI: 10.1177/10600280211041907] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To review the pharmacological and clinical profile of ozanimod in the treatment of ulcerative colitis (UC). DATA SOURCES A PubMed search was conducted from inception to July 2021 using the keywords ozanimod, ulcerative colitis, and sphingosine 1-phosphate receptor modulator. Information was also extracted from published abstracts and the package insert. STUDY SELECTION AND DATA EXTRACTION Phase 2 and 3 studies and relevant literature on ozanimod pharmacological and clinical profiles were reviewed. DATA SYNTHESIS Ozanimod approval was based on True North, a phase 3 trial evaluating ozanimod's efficacy and safety in the treatment of moderate to severe UC. Compared with placebo, ozanimod led to clinical remission in a significantly higher proportion of patients in both the induction and maintenance phase. Additionally, for secondary end points of clinical response, endoscopic improvement, corticosteroid-free remission, and mucosal healing, ozanimod performed significantly better than placebo. Common adverse events included infections, headaches, hypertension, bradycardia, and liver enzyme elevations. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Ozanimod is the first sphingosine 1-phosphate modulator to be approved for UC and is administered orally. Its efficacy profile is comparable with other UC medications. However, its safety profile is unique, requiring extensive assessments prior to initiation of and during treatment. Thus, it is unclear how ozanimod will be positioned in UC treatment. CONCLUSION Ozanimod is another option in the growing arsenal of UC treatment. Although it offers a novel mechanism of action and is administered orally, there are important safety, dosing, and pharmacokinetic factors to consider prior to initiation and use.
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Affiliation(s)
- David Choi
- University of Chicago Medicine, Chicago, IL, USA
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Leukocytosis Associated with Clozapine Treatment: A Case Series and Systematic Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57080816. [PMID: 34441022 PMCID: PMC8399375 DOI: 10.3390/medicina57080816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics, clozapine remains underutilized. Clozapine monitoring systems clearly describe the proposed management of clozapine-induced neutropenia; however, no specific mention is made of how to interpret neutrophilic leukocytosis, despite that being a relatively frequent finding. Prescribers unfamiliar with this molecule may misjudge its clinical significance, potentially leading to untimely treatment interruption. Here, we systematically review the literature on the risk of neutrophilic leukocytosis during clozapine treatment, and describe eight additional cases among our patient cohort. MATERIALS AND METHODS We performed a systematic review of the literature on PubMed and Embase using the PRISMA 2020 guidelines, and selected all original reports describing either (1) the prevalence of neutrophilic leukocytosis during clozapine treatment, or (2) the clinical significance of neutrophilic leukocytosis. We described eight additional cases of neutrophilic leukocytosis during clozapine treatment while attending an outpatient psychiatric clinic. RESULTS Our research ultimately yielded the selection of 13 articles included in this systematic review. The case series highlighted the presence of stable and clinically unremarkable neutrophilia during a follow-up ranging from one to ten years. CONCLUSIONS Existing evidence indicates that leukocytosis associated with clozapine treatment can be considered as an asymptomatic and benign condition, suggesting that no change in clozapine treatment is needed upon its detection.
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Campesi I, Racagni G, Franconi F. Just a Reflection: Does Drug Repurposing Perpetuate Sex-Gender Bias in the Safety Profile? Pharmaceuticals (Basel) 2021; 14:730. [PMID: 34451827 PMCID: PMC8402096 DOI: 10.3390/ph14080730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 02/08/2023] Open
Abstract
Vaccines constitute a strategy to reduce the burden of COVID-19, but the treatment of COVID-19 is still a challenge. The lack of approved drugs for severe COVID-19 makes repurposing or repositioning of approved drugs a relevant approach because it occurs at lower costs and in a shorter time. Most preclinical and clinical tests, including safety and pharmacokinetic profiles, were already performed. However, infective and inflammatory diseases such as COVID-19 are linked with hypoalbuminemia and downregulation of both phase I and phase II drug-metabolizing enzymes and transporters, which can occur in modifications of pharmacokinetics and consequentially of safety profiles. This appears to occur in a sex- and gender-specific way because of the sex and gender differences present in the immune system and inflammation, which, in turn, reflect on pharmacokinetic parameters. Therefore, to make better decisions about drug dosage regimens and to increases the safety profile in patients suffering from infective and inflammatory diseases such as COVID-19, it is urgently needed to study repurposing or repositioning drugs in men and in women paying attention to pharmacokinetics, especially for those drugs that are previously scarcely evaluated in women.
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Affiliation(s)
- Ilaria Campesi
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy
- National Laboratory of Pharmacology and Gender Medicine, National Institute of Biostructure and Biosystem, 07100 Sassari, Italy;
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy;
| | - Flavia Franconi
- National Laboratory of Pharmacology and Gender Medicine, National Institute of Biostructure and Biosystem, 07100 Sassari, Italy;
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Second-Line Bismuth-Containing Quadruple Therapy for Helicobacterpylori Infection: A 12-Year Study of Annual Eradication Rates. J Clin Med 2021; 10:jcm10153273. [PMID: 34362057 PMCID: PMC8347213 DOI: 10.3390/jcm10153273] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Bismuth-containing quadruple therapy (BQT) consisting of a proton-pump inhibitor (PPI), bismuth, metronidazole and tetracycline is recommended as a second-line treatment for Helicobacter pylori (H. pylori) infection when PPI-based standard triple therapy (STT) consisting of a PPI, amoxicillin and clarithromycin is unsuccessful. The purpose of this study was to analyze the long-term results of BQT as a second-line therapy to determine its effectiveness. Methods: This study included 643 subjects who failed first-line STT and received 7 or 10–14 days of BQT as a second-line therapy. We retrospectively analyzed the annual H. pylori eradication rates, demographic factors and adverse events. Results: The overall eradication rates by intention-to-treat (ITT) and per-protocol (PP) analyses were 80.7% (519/643) and 93.3% (519/556), respectively. By PP analysis, the eradication rates for 2008–2011, 2012–2015, and 2016–2019 were 93.3%, 91.0%, and 96.4%, respectively (p = 0.145). There were no significant differences between the 7-day group and the 10–14-day group in both the ITT (79.7% vs. 86.0%, p = 0.148) and the PP analyses (92.7% vs. 96.6%, p = 0.187). A multivariate analysis showed that current smoking was associated with eradication failure. Eighty-nine subjects (16.0%) suffered adverse events, mainly gastrointestinal symptoms, but only six cases were severe. Conclusions: BQT as a second-line therapy is an effective treatment for H. pylori. Treatment for 10–14 days showed a higher eradication rate compared with a 7-day regimen, but not significantly.
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Cardoso ADOP, Pecli E Silva C, Dos Anjos FDF, Quesnot N, Valenca HDM, Cattani-Cavalieri I, Brito-Gitirana L, Valenca SS, Lanzetti M. Diallyl disulfide prevents cigarette smoke-induced emphysema in mice. Pulm Pharmacol Ther 2021; 69:102053. [PMID: 34214692 DOI: 10.1016/j.pupt.2021.102053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cigarette smoke (CS) is the main risk factor for the development of chronic obstructive pulmonary disease (COPD) and pulmonary emphysema. The use of antioxidants has emerged as a potential therapeutic strategy to treat airway inflammation and lung diseases. In the current study, we investigated the potential therapeutic impact of diallyl disulfide (Dads) treatment in a murine model of CS-induced emphysema. METHODS C57BL/6 mice were exposed to CS for 60 consecutive days and treated with vehicle or Dads (30, 60 or 90 mg/kg) by oral gavage for the last 30 days, three times/week. The control group was sham-smoked and received vehicle treatment. All mice were euthanized 24 h after day 60; bronchoalveolar lavage (BAL) was performed and lungs were processed for further experimentation. Histological (HE stained sections, assessment of mean linear intercept (Lm)), biochemical (nitrite, superoxide dismutase (SOD), glutathione transferase (GST), and malondialdehyde (MDA) equivalents), and molecular biology (metalloproteinase (MMP) 12, SOD2, carbonyl reductase 1 (CBR1), nitrotyrosine (PNK), 4-hydroxynonenal (4-HNE), and CYP2E1) analyses were performed. RESULTS Treatment with Dads dose-dependently reduced CS-induced leukocyte infiltration into the airways (based on BAL fluid counts) and improved lung histology (indicated by a reduction of Lm). Furthermore, CS exposure dramatically reduced the activity of the antioxidant enzymes SOD and GST in lung tissue and increased nitrite and MDA levels in BAL; these effects were all effectively counteracted by Dads treatment. Western blot analysis further confirmed the antioxidant potential of Dads, showing that treatment prevented the CS-induced decrease in SOD2 expression and increase in lung damage markers, such as CBR1, PNK, and 4-HNE. Furthermore, increased MMP12 (an important hallmark of CS-induced emphysema) and CYP2E1 lung protein levels were significantly reduced in mice receiving Dads treatment. CONCLUSION Our findings demonstrate that treatment with Dads is effective in preventing multiple pathological features of CS-induced emphysema in an in vivo mouse model. In addition, we have identified several proteins/enzymes, including 4-HNE, CBR1, and CYP2E1, that are modifiable by Dads and could represent specific therapeutic targets for the treatment of COPD and emphysema.
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Affiliation(s)
| | - Cyntia Pecli E Silva
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nicolas Quesnot
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Helber da Maia Valenca
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lycia Brito-Gitirana
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel Santos Valenca
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Manuella Lanzetti
- Instituto de Ciências Biomédicas, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
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Joshi S, Tepper SJ, Lucas S, Rasmussen S, Nelson R. A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. Headache 2021; 61:838-853. [PMID: 34214182 PMCID: PMC8361687 DOI: 10.1111/head.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022]
Abstract
Objective To review the pharmacokinetics of major classes of migraine preventives and the clinical implications of drug–drug interactions (DDIs) with the use of these therapies in migraine management. Background Preventive treatments for migraine are recommended for a large proportion of patients with frequent migraine attacks. These patients often exhibit a number of comorbidities, which may lead to the introduction of multiple concomitant therapies. Potential DDIs must be considered when using polytherapy to avoid increased risk of adverse events (AEs) or inadequate treatment of comorbid conditions. Methods A literature search was performed to identify pharmacokinetic properties and potential DDIs of beta‐blockers, antiepileptic drugs, antidepressants, calcium channel blockers, gepants, and monoclonal antibody therapies targeting the calcitonin gene‐related peptide pathway with medications that may be used for comorbid conditions. Results Most DDIs occur through alterations in cytochrome P450 isoenzyme activity and may be complicated by genetic polymorphism for metabolic enzymes. Additionally, drug metabolism may be altered by grapefruit juice ingestion and smoking. The use of migraine preventive therapies may exacerbate symptoms of comorbid conditions or increase the risk of AEs associated with comorbid conditions as a result of DDIs. Conclusions DDIs are important to consider in patients with migraine who use multiple medications. The development of migraine‐specific evidence‐based preventive treatments allows for tailored clinical management that reduces the risk of DDIs and associated AEs in patients with comorbidities.
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Affiliation(s)
- Shivang Joshi
- Neurology/Headache Medicine, DENT Neurologic Institute, Amherst, NY, USA
| | - Stewart J Tepper
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sylvia Lucas
- Department of Neurology, University of Washington Medical Centers, Seattle, WA, USA
| | | | - Rob Nelson
- Global Medical, Amgen Inc., Thousand Oaks, CA, USA.,US Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
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Kunas SL, Hilbert K, Yang Y, Richter J, Hamm A, Wittmann A, Ströhle A, Pfleiderer B, Herrmann MJ, Lang T, Lotze M, Deckert J, Arolt V, Wittchen HU, Straube B, Kircher T, Gerlach AL, Lueken U. The modulating impact of cigarette smoking on brain structure in panic disorder: a voxel-based morphometry study. Soc Cogn Affect Neurosci 2021; 15:849-859. [PMID: 32734299 PMCID: PMC7543937 DOI: 10.1093/scan/nsaa103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
Cigarette smoking increases the likelihood of developing anxiety disorders, among them panic disorder (PD). While brain structures altered by smoking partly overlap with morphological changes identified in PD, the modulating impact of smoking as a potential confounder on structural alterations in PD has not yet been addressed. In total, 143 PD patients (71 smokers) and 178 healthy controls (62 smokers) participated in a multicenter magnetic resonance imaging (MRI) study. T1-weighted images were used to examine brain structural alterations using voxel-based morphometry in a priori defined regions of the defensive system network. PD was associated with gray matter volume reductions in the amygdala and hippocampus. This difference was driven by non-smokers and absent in smoking subjects. Bilateral amygdala volumes were reduced with increasing health burden (neither PD nor smoking > either PD or smoking > both PD and smoking). As smoking can narrow or diminish commonly observed structural abnormalities in PD, the effect of smoking should be considered in MRI studies focusing on patients with pathological forms of fear and anxiety. Future studies are needed to determine if smoking may increase the risk for subsequent psychopathology via brain functional or structural alterations.
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Affiliation(s)
- Stefanie L Kunas
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - Alfons Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - André Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, University of Münster, Münster 48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Bremen 28359, Germany.,Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg 20146, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald 17489, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster 48149, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden 01069, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Alexander L Gerlach
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
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Grubb AF, Greene SJ, Fudim M, Dewald T, Mentz RJ. Drugs of Abuse and Heart Failure. J Card Fail 2021; 27:1260-1275. [PMID: 34133967 DOI: 10.1016/j.cardfail.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Substance use is common among those with heart failure (HF) and is associated with worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused substances that can contribute to the development and worsening of HF. Heavy alcohol consumption can lead to dilated cardiomyopathy, whereas moderate intake may decrease incident HF. Tobacco increases the risk of HF through coronary artery disease and coronary artery disease-independent mechanisms. Continued smoking worsens outcomes for those with HF and cessation is associated with an improved risk of major adverse cardiac events. Cannabis has complex interactions on the cardiovascular system depending on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol can increase sympathetic tone, cause vascular dysfunction, and may increase the risk of myocardial infarction. Cannabidiol is cardioprotective in preclinical studies and is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent proarrhythmogenic agent. It increases the risk of myocardial infarction and can also lead to a dilated cardiomyopathy. The use of beta-blockers in those with HF and cocaine use is likely safe and effective. Future studies are needed to further elucidate the impact of these substances both on the development of HF and their effects on those who have HF.
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Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, Durham, North Carolina.
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Tracy Dewald
- Department of Medicine, Division of Clinical Pharmacology Durham, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Alkattan A, Alsalameen E. Polymorphisms of genes related to phase-I metabolic enzymes affecting the clinical efficacy and safety of clopidogrel treatment. Expert Opin Drug Metab Toxicol 2021; 17:685-695. [PMID: 33931001 DOI: 10.1080/17425255.2021.1925249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Clopidogrel is an antiplatelet medication described as a prodrug, which cannot exert the antiplatelet effect until being biotransformed to the active metabolite. It is commonly used to reduce the risk of blood coagulation in patients diagnosed with acute coronary syndrome, or ischemic stroke.Area covered: We reviewed published articles in PubMed and Google Scholar that focused on the mutations of CYP2C19, CYP3A4, CYP2C9, CYP2B6, and CYP1A2 genes related to clopidogrel clinical efficacy and safety.Expert opinion: Based on current pharmacogenetic studies, patients carrying CYP2C19*2, CYP2C19*3, CYP2C9*3, and CYP2B6*5 alleles may not respond to clopidogrel due to poor platelet inhibition efficacy revealed among them. In contrast, carriers of CYP2C19*17, CYP3A4*1G, and CYP1A2*1C alleles showed a more significant antiplatelet effect in clopidogrel users and expected to have a protective role as a genetic factor against cardiovascular events. Genotyping for either CYP2C19, CYP3A4, CYP2C9, CYP2B6, or CYP1A2 variants is not recommended when considering clopidogrel treatment for patients, as some trials showed specific non-genetic factors (e.g. age and diabetes) that could affect clopidogrel responsiveness. Instead, platelets inhibition tests could be used as predictors of the clinical efficacy of clopidogrel treatment. Other P2Y12 receptor inhibitors should be considered as alternative medications.
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Affiliation(s)
- Abdullah Alkattan
- Department of Research and Development, General Directorate of Medical Consultations, Assisting Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia.,Department of Biomedical Sciences, College of Veterinary Medicine, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Eman Alsalameen
- Department of Pharmacy, King Khaled University Hospital, Medical City King Saud University, Riyadh, Saudi Arabia
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Henderson LM, Hopkins SE, Boyer BB, Thornton TA, Rettie AE, Thummel KE. In Vivo Functional Effects of CYP2C9 M1L, a Novel and Common Variant in the Yup'ik Alaska Native Population. Drug Metab Dispos 2021; 49:345-352. [PMID: 33632714 PMCID: PMC8008381 DOI: 10.1124/dmd.120.000301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/04/2021] [Indexed: 12/03/2022] Open
Abstract
Alaska Native people are under-represented in genetic research but have unique gene variation that may critically impact their response to pharmacotherapy. Full resequencing of CYP2C9 in a cross-section of this population identified CYP2C9 Met1Leu (M1L), a novel, relatively common single nucleotide polymorphism hypothesized to confer CYP2C9 poor metabolizer phenotype by disrupting the start codon. M1L is present at a minor allele frequency of 6.3% in Yup'ik Alaska Native people and thus can contribute to the risk of an adverse drug response from narrow-therapeutic-index CYP2C9 substrates such as (S)-warfarin. This study's objective was to characterize the catalytic efficiency of the Leu1 variant enzyme in vivo by evaluating the pharmacokinetic behavior of naproxen, a probe substrate for CYP2C9 activity, in genotyped Yup'ik participants. We first confirmed the selectivity of (S)-naproxen O-demethylation by CYP2C9 using activity-phenotyped human liver microsomes and selective cytochrome P450 inhibitors and then developed and validated a novel liquid chromatography mass spectrometry method for simultaneous quantification of (S)-naproxen, (S)-O-desmethylnaproxen, and naproxen acyl glucuronide in human urine. The average ratio of (S)-O-desmethylnaproxen to unchanged (S)-naproxen in urine was 18.0 ± 8.0 (n = 11) for the homozygous CYP2C9Met1 reference group and 10.3 ± 6.6 (n = 11) for the Leu1 variant carrier group (P = 0.011). The effect of M1L variation on CYP2C9 function and its potential to alter the pharmacokinetics of drugs metabolized by the enzyme has clinical implications and should be included in a variant screening panel when pharmacogenetic testing in the Alaska Native population is warranted. SIGNIFICANCE STATEMENT: The novel CYP2C9 Met1Leu variant in Alaska Native people was recently identified. This study validated (S)-naproxen as a CYP2C9 probe substrate to characterize the in vivo functional activity of the CYP2C9 Leu1 variant. The results of this pharmacogenetic-pharmacokinetic study suggest that the CYP2C9 Leu1 variant exhibits loss of enzyme activity. This finding may be important to consider when administering narrow-therapeutic-index medications metabolized by CYP2C9 and also compels further investigation to characterize novel genetic variation in understudied populations.
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Affiliation(s)
- Lindsay M Henderson
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
| | - Scarlett E Hopkins
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
| | - Bert B Boyer
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
| | - Timothy A Thornton
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
| | - Allan E Rettie
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
| | - Kenneth E Thummel
- Departments of Pharmaceutics (L.M.H., K.E.T.), Biostatistics (T.A.T.), and Medicinal Chemistry (A.E.R.), University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology (S.E.H., B.B.B.), Oregon Health & Science University, Portland, Oregon
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Population Pharmacokinetics of Ibrutinib in Healthy Adults. Eur J Drug Metab Pharmacokinet 2021; 46:405-413. [PMID: 33740218 DOI: 10.1007/s13318-021-00679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Ibrutinib is an antineoplastic agent that reduces B-cell proliferation by inhibiting Bruton's tyrosine kinase. We describes population pharmacokinetics of ibrutinib in healthy adults, and explores potential patient characteristics associated with ibrutinib pharmacokinetics. METHODS A population pharmacokinetic modeling approach was applied to 39 healthy subjects. Modeling was performed using Monolix (v.2019R2). Serial blood samples to measure the plasma ibrutinib concentration were collected following the oral administration of 140 mg ibrutinib on two different occasions under fasting conditions. Demographic and clinical information were evaluated as possible predictors of ibrutinib pharmacokinetics during model development. Simulations (using mlxR: R package v.4.0.2) following the administration of therapeutic doses were performed to explore the clinical implications of identified covariates on ibrutinib steady-state concentrations. RESULTS A two-compartment model with zero order absorption best fit the data. Inter-individual and inter-occasion variability were quantified by the proposed model. We identified smoking status as a significant covariate associated with ibrutinib clearance. Smoking was found to increase ibrutinib clearance by approximately 60%, which resulted in a reduction in simulated steady-state concentrations by around 40%. CONCLUSION The model can be used to simulate clinical trials or various dosing scenarios. The proposed model can be used to optimize ibrutinib dosing based on the smoking status.
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Eurotium cristatum Fermented Loose Dark Tea Ameliorates Cigarette Smoke-Induced Lung Injury by MAPK Pathway and Enhances Hepatic Metabolic Detoxification by PXR/ AhR Pathway in Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6635080. [PMID: 33777316 PMCID: PMC7972846 DOI: 10.1155/2021/6635080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/05/2021] [Accepted: 02/26/2021] [Indexed: 01/28/2023]
Abstract
Cigarette smoke- (CS-) induced oxidative stress and inflammation in the lung are serious health problems. Primary and reprocessed tea products contain multiple antioxidants that have been reported to protect the lung against CS-induced injury. However, the beneficial effects of Eurotium cristatum fermented loose dark tea (ECT) and Eurotium cristatum particle metabolites (ECP) on CS-induced lung injury and its potential hepatic metabolic detoxification are still unclear. Therefore, sixty mice were randomly divided into six equal groups. CS-exposed mice were prevented or treated with ECP or ECT infusions for 12 or 8 weeks to determine the antioxidative stress, anti-inflammatory and potential metabolic detoxification of ECT and ECP. Thirty-six mice were randomly divided into six equal groups to observe the effects on hepatic metabolic detoxification by replacing daily drinking water with ECT. Results showed that CS significantly decreased the activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) and upregulated the expressions of malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-8, and IL-1β in serum. These adverse effects were modulated by ECP and ECT. In addition, ECT upregulated the mRNA expression of pregnane X receptor (PXR) and cytochrome P450 (CYP450) in the liver on daily free drinking ECT mice group. Western blot analysis further revealed that in CS-exposed mice, ECP and ECT significantly decreased the phosphorylation of mitogen-activated protein kinase (MAPK) in the lung but upregulated the protein expressions of PXR and aryl hydrocarbon receptor (AhR) in the liver. Overall, our findings demonstrated that ECT and ECP protected against lung injury induced by CS via MAPK pathway and enhanced hepatic metabolic detoxification via PXR and AhR pathways. Therefore, daily intake of ECT and ECP can potentially protect against CS-induced oxidative and inflammatory injuries.
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Balayssac D. [Relation between tobacco smoking and pain: A narrative review of the scientific literature]. Rev Mal Respir 2021; 38:269-277. [PMID: 33648775 DOI: 10.1016/j.rmr.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Tobacco smoking and pain have an intimate, complex, two-way interaction. The purpose of this narrative review of the literature is to present what is currently understood about the relationship. STATE OF KNOWLEDGE Tobacco smoking (and the associated chronic exposure to nicotine) has been defined as a risk factor for chronic pain, involving nociceptive sensitisation. For people who smoke, pain will be both a motivational factor for tobacco consumption and a barrier to tobacco use cessation. Conversely, nicotine (acute exposure) has clearly demonstrated analgesic properties, mediated in particular by activation of nicotinic acetylcholine receptors. PERSPECTIVES The management of pain in people who smoke is still largely unaddressed, and further studies will be needed to develop effective strategies for tobacco use cessation in this context. Nicotine and modulators of nicotinic acetylcholine receptors represent innovative strategies for the discovery of new analgesics. CONCLUSIONS The effects of smoking on pain, chronic nociceptive sensitisation and acute analgesia, serve to maintain tobacco consumption via negative reinforcement. A holistic therapeutic strategy is necessary to maximise the likelihood of successful smoking cessation.
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Affiliation(s)
- D Balayssac
- Université Clermont Auvergne, Inserm U1107 Neuro-Dol, Laboratoire de toxicologie, CHU Clermont-Ferrand, Direction de la recherche clinique et de l'innovation, 63000 Clermont-Ferrand, France.
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Baek IH, Back HM, Chae JW, Ha ES, Park H, Choi DH, Staatz CE, Kim MS. Pharmacokinetics of eperisone following oral administration in healthy Korean volunteers. Biopharm Drug Dispos 2021; 42:94-102. [PMID: 33527395 DOI: 10.1002/bdd.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 01/24/2021] [Indexed: 11/05/2022]
Abstract
Eperisone is an oral muscle relaxant used to treat musculoskeletal diseases, which exhibits high pharmacokinetic (PK) variability in bioequivalence studies. The aim of this study was to characterize the PKs of eperisone following its oral administration to Korean volunteers through the conduct of a noncompartmental and population analysis. A total of 360 concentration-time measurements collected on two separate occasions from 15 healthy volunteers during a bioequivalent study of eperisone 50 mg (Murex® ) were used in the PK analysis. Noncompartmental analysis was performed using WinNonLinTM and population analysis was performed using NONMEM® . The possible influence of thirty demographic and pathophysiological characteristics on the PKs of eperisone were explored. Based on noncompartmental analysis mean eperisone elimination half-life, apparent clearance (CL/F), and apparent volume of distribution were estimated to be 3.81 h, 39.24 × 103 l/h × 103 L, respectively. During population PK modeling a two-compartment model with first-order absorption rate constant (typical population K a = 1.5 h-1 ) and first-order elimination (typical population CL/F and apparent volume of distribution in the central compartment [V c /F] = 30.8 × 103 l/h and 86.2 × 103 l, respectively) best described the PKs of eperisone. Interindividual variability in CL/F and V c /F were estimated to be 87.9% and 130.3%, respectively and interoccasion variability in CL/F and V c /F were estimated to be 23.8% and 30.8%, respectively. Aspartate aminotransferase level and smoking status were identified as potential covariates that may influence the CL/F of eperisone. This is the first study to develop a disposition model for eperisone and investigate the potential influence of covariate factors on it PK variability.
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Affiliation(s)
- In-Hwan Baek
- College of Pharmacy, Kyungsung University, Busan, Republic of Korea
| | - Hyun-Moon Back
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Jung-Woo Chae
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Sol Ha
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Heejun Park
- College of Pharmacy, Duksung Women's University, Seoul, Republic of Korea
| | - Du Hyung Choi
- Department of Pharmaceutical Engineering, Inje University, Gyeongnam, Republic of Korea
| | - Christine E Staatz
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, Brisbane, Queensland, Australia
| | - Min-Soo Kim
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
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Barrangou-Poueys-Darlas M, Guerlais M, Laforgue EJ, Bellouard R, Istvan M, Chauvin P, Guillet JY, Jolliet P, Gregoire M, Victorri-Vigneau C. CYP1A2 and tobacco interaction: a major pharmacokinetic challenge during smoking cessation. Drug Metab Rev 2021; 53:30-44. [PMID: 33325257 DOI: 10.1080/03602532.2020.1859528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
Smoking cessation is underestimated in terms of drug interactions. Abrupt smoking cessation is common in cases of emergency hospitalization and restrictions of movement. Tobacco is a known cytochrome P450 1A2 (CYP1A2) inducer, its consumption and withdrawal can lead to major pharmacokinetic drug interactions. Nevertheless, references do exist, but may have different results between them. The objective of our work was to establish the broadest and most consensual list as possible of CYP1A2 substrates treatments and propose a pharmacological approach. We searched the widest possible list of CYP1A2 substrates based on various international references. We compared the references and defined probability and reliability scores of our results to sort the substances based on the scores. For the 245 substances identified as CYP1A2 substrates, we focused on the 63 CYP1A2 substrates with both probability and reliability scores >50%. Our work establishes adaptive pharmacological approaches for the management of patients initiating smoking cessation which must be integrated into the management of smoking cessation. Pharmacologists can now adopt adaptive pharmacological approaches to complement patient-specific clinical information about smoking cessation by considering pharmacokinetic risk. This work establishes an unprecedented list. It should guide in the care of patients initiating smoking cessation to prevent pharmacokinetic drug interactions.
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Affiliation(s)
| | - Marylène Guerlais
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
| | - Edouard-Jules Laforgue
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
- Addictology and Psychiatry Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1246 SPHERE (methodS in Patients-centered outcomes and HEalth Research), Nantes and Tours Universities, Nantes, France
| | - Ronan Bellouard
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
| | - Marion Istvan
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
| | - Pascale Chauvin
- Addictology Regional Network (URAA), Structure Régionale d'Appui et d'Expertise Addictologie des Pays de la Loire, Nantes, France
| | - Jean-Yves Guillet
- Addictology Regional Network (URAA), Structure Régionale d'Appui et d'Expertise Addictologie des Pays de la Loire, Nantes, France
| | - Pascale Jolliet
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1246 SPHERE (methodS in Patients-centered outcomes and HEalth Research), Nantes and Tours Universities, Nantes, France
| | - Matthieu Gregoire
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1235 The Enteric Nervous System in Gut and Brain Disorders, University of Nantes, Nantes, France
| | - Caroline Victorri-Vigneau
- Clinical Pharmacology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1246 SPHERE (methodS in Patients-centered outcomes and HEalth Research), Nantes and Tours Universities, Nantes, France
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Evins AE, West R, Benowitz NL, Russ C, Lawrence D, McRae T, Maravic MC, Heffner JL, Anthenelli RM. Efficacy and Safety of Pharmacotherapeutic Smoking Cessation Aids in Schizophrenia Spectrum Disorders: Subgroup Analysis of EAGLES. Psychiatr Serv 2021; 72:7-15. [PMID: 33138708 DOI: 10.1176/appi.ps.202000032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of varenicline, bupropion, and nicotine replacement therapy (NRT) among smokers with schizophrenia spectrum disorders in post hoc analyses of Evaluating Adverse Events in a Global Smoking Cessation Study data. METHODS Smokers with schizophrenia spectrum disorder (N=390) and without a psychiatric illness (control group, N=4,028) were randomly assigned to receive varenicline, bupropion, NRT patch, or placebo for 12 weeks. Outcomes included abstinence rates during treatment and follow-up, number needed to treat (NNT) for abstinence, incidence of neuropsychiatric adverse events (NPSAEs), and temporal relationship between NPSAEs and abstinence status. RESULTS Smokers with schizophrenia smoked more and had greater dependence and fewer prior trials of cessation pharmacotherapy at baseline. At each time point, smokers with schizophrenia assigned to varenicline had significantly greater odds of abstinence compared with their matched placebo group, with NNT comparable to the control group. Bupropion and NRT increased odds of abstinence; confidence intervals (CIs) included 1 for some comparisons, and NNT for smokers with schizophrenia was greater than for the control group. No treatment was associated with significantly more NPSAEs, compared with placebo, in either cohort. The estimated NPSAE rate was 5% (95% CI=3.0-7.7) for smokers with schizophrenia and 1% (95% CI=0.6-2.1) for the control group. Over one-third of NPSAEs occurred during partial or full abstinence, suggesting a multifactorial nature. CONCLUSIONS For smokers with schizophrenia, varenicline led to significantly higher abstinence rates, and NNT was comparable to the control group. A significant proportion of NPSAEs occurred during early abstinence. No treatment significantly increased NPSAE prevalence.
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Affiliation(s)
- A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert West
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Neal L Benowitz
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Cristina Russ
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - David Lawrence
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Thomas McRae
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Melissa Culhane Maravic
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Jaimee L Heffner
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert M Anthenelli
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
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Abdellateif MS, Salem SE, Badr DM, Shaarawy S, Hussein MM, Zekri ARN, Fouad MA. The Prognostic Significance of 5-Fluorouracil Induced Inflammation and Immuno-Modulation in Colorectal Cancer Patients. J Inflamm Res 2020; 13:1245-1259. [PMID: 33408498 PMCID: PMC7781028 DOI: 10.2147/jir.s283069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
Aim The change in the levels of peripheral inflammatory markers together with EGFR in relation to 5- fluorouracil (5-FU) therapy was evaluated for their prognostic significance in colorectal cancer (CRC) patients. Patients and Methods Expression levels of COX2, IL6, IL1β, EGFR, IL10, and TNFα were determined with quantitative real-time PCR (qPCR) in the peripheral blood of 90 CRC patients. The inflammatory response was correlated with patients’ clinical features, disease-free survival (DFS), and overall survival (OS). Results After 6 months of 5-FU therapy, increased inflammatory response was found to be associated with smoking, T3 or T4 tumors, performance status (PS) III, positive lymph nodes, distant metastasis, and gastrointestinal (GIT) toxicity. The combination of COX2 with interleukins in a predictive equation for DFS was significant in patients with over-expression of EGFR. DFS and OS rates were reduced in patients with increased COX2, IL6, IL10, and TNFα expression with 5-FU therapy. Significant hazard of disease progression was associated with smoking (HR=1.27, P=0.004), 5-FU induction of COX2, and IL6 expression (HR=1.35, P=0.001 and HR=1.27, P=0.004, respectively). Moreover, smoking, 5-FU induction of IL6, TNFα, and IL10 expression are found to be independent prognostic factors for OS (P=0.003, 0.003, 0.002, and 0.002, respectively). Conclusion The peripheral effects of 5-FU therapy have shown a significant impact on the treatment outcome of CRC patients.
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Affiliation(s)
- Mona S Abdellateif
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Salem E Salem
- Medical Oncology Department, National Cancer Institute, Cairo, Egypt
| | - Doaa M Badr
- Pharmacology and Experimental Oncology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sabry Shaarawy
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Marwa M Hussein
- Medical Oncology Department, National Cancer Institute, Cairo, Egypt
| | - Abdel-Rahman N Zekri
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo, Egypt
| | - Mariam A Fouad
- Pharmacology and Experimental Oncology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Stigliano G, Miuli A, Vizziello A, Altomare AI, Lalli A, Alessi MC, Sociali A, Rucco A, Vannini C, Martinotti G, di Giannantonio M. Use and knowledge of novel synthetic opioids: An Italian survey. J Ethn Subst Abuse 2020; 21:1-11. [PMID: 33315542 DOI: 10.1080/15332640.2020.1852143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The recreational use of novel synthetic opioids (NSOs) is increasing, especially among the youngest part of the population. We conducted a naturalistic observational survey. The main outcome was to assess the use and the knowledge of NSOs among the youngest population in Italy. A sociodemographic questionnaire was also administrated. Nine hundred twenty questionnaires were completed. Fentanyl was the most used NSO (1.63% of the subjects). In all, 14.3% of the sample revealed awareness of NSOs. Although the diffusion in Italy is small, the large knowledge of NSOs requires future monitoring of this phenomenon.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giovanni Martinotti
- "G. d'Annunzio" University, Chieti, Italy
- University of Hertfordshire, Herts, UK
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Drug-Drug Interactions Involving Intestinal and Hepatic CYP1A Enzymes. Pharmaceutics 2020; 12:pharmaceutics12121201. [PMID: 33322313 PMCID: PMC7764576 DOI: 10.3390/pharmaceutics12121201] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
Cytochrome P450 (CYP) 1A enzymes are considerably expressed in the human intestine and liver and involved in the biotransformation of about 10% of marketed drugs. Despite this doubtless clinical relevance, CYP1A1 and CYP1A2 are still somewhat underestimated in terms of unwanted side effects and drug–drug interactions of their respective substrates. In contrast to this, many frequently prescribed drugs that are subjected to extensive CYP1A-mediated metabolism show a narrow therapeutic index and serious adverse drug reactions. Consequently, those drugs are vulnerable to any kind of inhibition or induction in the expression and function of CYP1A. However, available in vitro data are not necessarily predictive for the occurrence of clinically relevant drug–drug interactions. Thus, this review aims to provide an up-to-date summary on the expression, regulation, function, and drug–drug interactions of CYP1A enzymes in humans.
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Carvalho Henriques B, Yang EH, Lapetina D, Carr MS, Yavorskyy V, Hague J, Aitchison KJ. How Can Drug Metabolism and Transporter Genetics Inform Psychotropic Prescribing? Front Genet 2020; 11:491895. [PMID: 33363564 PMCID: PMC7753050 DOI: 10.3389/fgene.2020.491895] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Many genetic variants in drug metabolizing enzymes and transporters have been shown to be relevant for treating psychiatric disorders. Associations are strong enough to feature on drug labels and for prescribing guidelines based on such data. A range of commercial tests are available; however, there is variability in included genetic variants, methodology, and interpretation. We herein provide relevant background for understanding clinical associations with specific variants, other factors that are relevant to consider when interpreting such data (such as age, gender, drug-drug interactions), and summarize the data relevant to clinical utility of pharmacogenetic testing in psychiatry and the available prescribing guidelines. We also highlight areas for future research focus in this field.
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Affiliation(s)
| | - Esther H. Yang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Diego Lapetina
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Michael S. Carr
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Vasyl Yavorskyy
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Joshua Hague
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Katherine J. Aitchison
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Gao Y, Miksys S, Palmour RM, Tyndale RF. The Influence of Tobacco Smoke/Nicotine on CYP2A Expression in Human and African Green Monkey Lungs. Mol Pharmacol 2020; 98:658-668. [PMID: 33055223 DOI: 10.1124/molpharm.120.000100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
CYP2A enzymes metabolically inactivate nicotine and activate tobacco-derived procarcinogens [e.g., 4-[methylnitrosamino]-1-(3-pyridyl)-1-butanone]. Smoking decreases nicotine clearance, and chronic nicotine reduces hepatic CYP2A activity. However, little is known about the impact of smoking or nicotine on the expression of CYP2A in the lung. We investigated 1) the levels of human lung CYP2A mRNA in smokers versus nonsmokers and 2) the impact of daily nicotine treatment on lung CYP2A protein levels in African green monkeys (AGMs). Lung CYP2A13, CYP2A6, and CYP2A7 (and CYP1A2) mRNA levels in smokers and nonsmokers were assessed in Gene Expression Omnibus data sets (GSE30063, GSE108134, and GSE11784). The impact of chronic, twice-daily, subcutaneous nicotine at two doses (0.3 and 0.5 mg/kg) versus vehicle on lung CYP2A protein levels was assessed. The impact of ethanol self-administration was also investigated, with and without nicotine treatment. Smokers versus nonsmokers (from GSE30063 and GSE108134) had lower (1.04- to 1.12-fold) levels of lung CYP2A13, CYP2A6, and CYP2A7 (and higher CYP1A2) mRNA. Both doses of nicotine tested decreased AGM lung CYP2A protein (3- to 7-fold). Ethanol self-administration had no effect on AGM lung CYP2A protein, and there was no interaction between ethanol and nicotine. Our results suggest that smoking was associated with a reduction in human lung CYP2A13, CYP2A6, and CYP2A7 mRNA, consistent with the role of nicotine treatment in reducing AGM lung CYP2A protein. This regulation by smoking/nicotine will increase interindividual variation in lung CYP2A levels, which may impact the localized metabolism of inhaled drugs and tobacco smoke procarcinogens. SIGNIFICANCE STATEMENT: CYP2A13 and CYP2A6 are expressed in the lung and may contribute to local procarcinogen activation. Smokers had lower lung CYP2A mRNA levels compared with nonsmokers. Lung CYP2A protein expression was decreased by systemic treatment with nicotine. Decreased lung CYP2A expression may alter smoking-related lung cancer risk and tissue damage from other inhaled toxins. This novel regulatory impact of nicotine, including nicotine found in smoking-cessation nicotine-replacement therapies, may have potential benefits on smoking-related lung cancer risk.
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Affiliation(s)
- Yuan Gao
- Department of Pharmacology and Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) (Y.G., S.M., R.F.T.) and Department of Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada and Department of Psychiatry and Human Genetics, McGill University, Montreal, Quebec, Canada (R.M.P.)
| | - Sharon Miksys
- Department of Pharmacology and Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) (Y.G., S.M., R.F.T.) and Department of Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada and Department of Psychiatry and Human Genetics, McGill University, Montreal, Quebec, Canada (R.M.P.)
| | - Roberta M Palmour
- Department of Pharmacology and Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) (Y.G., S.M., R.F.T.) and Department of Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada and Department of Psychiatry and Human Genetics, McGill University, Montreal, Quebec, Canada (R.M.P.)
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) (Y.G., S.M., R.F.T.) and Department of Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada and Department of Psychiatry and Human Genetics, McGill University, Montreal, Quebec, Canada (R.M.P.)
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Gorbovskaya I, Kanji S, Liu JCW, MacKenzie NE, Agarwal SM, Marshe VS, Sriretnakumar V, Verdu EF, Bercik P, De Palma G, Hahn MK, Müller DJ. Investigation of the Gut Microbiome in Patients with Schizophrenia and Clozapine-Induced Weight Gain: Protocol and Clinical Characteristics of First Patient Cohorts. Neuropsychobiology 2020; 79:5-12. [PMID: 30928978 DOI: 10.1159/000494696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emerging evidence suggests an important role of the human gut microbiome in psychiatry and neurodevelopmental disorders. An increasing body of literature based on animal studies has reported that the gut microbiome influences brain development and behavior by interacting with the gut-brain axis. Furthermore, as the gut microbiome has an important role in metabolism and is known to interact with pharmaceuticals, recent evidence suggests a role for the microbiome in antipsychotic-induced metabolic side effects in animals and humans. PURPOSE Here we present the protocol for a two-phase study investigating the gut microbiome in healthy controls and in patients with schizophrenia treated with antipsychotics. METHODS Phase I of our study involves humans exclusively. We recruit 25 patients who are chronically treated with clozapine and compare them with 25 healthy controls matched for age, sex, BMI, and smoking status. A second cohort consists of 25 patients newly starting on clozapine, and a third cohort includes 25 antipsychotic-naive patients. The patients in the second cohort and third cohort are prospectively assessed for up to 6 and 12 weeks, respectively. Phase II of this study will incorporate microbiota humanized mouse models to examine the influence of human fecal transplant on metabolic parameters and the gut-brain axis. Progress and Future Directions: We are underway with the first participants enrolled in all phase I treatment cohorts. This study will contribute to elucidating the role of the gut microbiome in schizophrenia and metabolic side effects. In addition, its results may help to explore potential therapeutic targets for antipsychotic-induced metabolic side effects.
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Affiliation(s)
- Ilona Gorbovskaya
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Kanji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jonathan C W Liu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sri Mahavir Agarwal
- Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Victoria S Marshe
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Venuja Sriretnakumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Giada De Palma
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margaret K Hahn
- Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, .,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada, .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, .,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada,
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73
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Chirehwa MT, Court R, de Kock M, Wiesner L, de Vries N, Harding J, Gumbo T, Maartens G, Warren R, Denti P, McIlleron H. Population Pharmacokinetics of Cycloserine and Pharmacokinetic/Pharmacodynamic Target Attainment in Multidrug-Resistant Tuberculosis Patients Dosed with Terizidone. Antimicrob Agents Chemother 2020; 64:e01381-20. [PMID: 32816738 PMCID: PMC7577169 DOI: 10.1128/aac.01381-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022] Open
Abstract
Cycloserine is a WHO group B drug for the treatment of multidrug-resistant tuberculosis (TB). Pharmacokinetic/pharmacodynamic data for cycloserine when dosed as terizidone are sparse. The aim of this analysis was to describe the population pharmacokinetics of cycloserine when administered as terizidone and predict the doses of terizidone attaining cycloserine exposures associated with efficacy. The plasma cycloserine level was measured 2 to 6 weeks after treatment initiation in patients hospitalized for second-line tuberculosis treatment. The pretreatment MICs of cycloserine were determined for the clinical isolates. We enrolled 132 participants with rifampicin-resistant TB; 79 were HIV positive. The median pretreatment MIC was 16 mg/liter. A one-compartment disposition model with two clearance pathways, nonrenal (0.35 liters/h) and renal (0.43 liters/h), described cycloserine pharmacokinetics well. Nonrenal clearance and the volume of distribution were allometrically scaled using fat-free mass. Smoking increased nonrenal clearance by 41%. Simulations showed that with daily doses of terizidone (750 mg and 1,000 mg for patients weighing ≤45 kg and >45 kg, respectively), the probability of maintaining the plasma cycloserine concentration above the MIC for more than 30% of the dosing interval (30% T>MIC) (which is associated with a 1.0-log10-CFU/ml kill in vitro) exceeded 90% at MIC values of ≤16 mg/liter, but the proportion of patients achieving 100% T>MIC (which is associated with the prevention of resistance) was more than 90% only at MICs of ≤8 mg/liter. Based on a target derived in vitro, the WHO-recommended doses of terizidone are effective for cycloserine MICs of ≤8 mg/liter, and higher doses are required to prevent the development of resistance.
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Affiliation(s)
- Maxwell T Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Richard Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mariana de Kock
- NRF-DSI Centre of Excellence in Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rob Warren
- NRF-DSI Centre of Excellence in Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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74
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Pirard C, Dufour P, Charlier C. Background contamination of perfluoralkyl substances in a Belgian general population. Toxicol Lett 2020; 333:13-21. [PMID: 32659468 DOI: 10.1016/j.toxlet.2020.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
The few Belgian studies on the human exposure to perfluoroalkyl substances (PFASs) have until now concerned the Northern part of Belgium (Flanders), while data related to Wallonia (South region) are missing. To fill this gap, 8 perfluorinated carboxylic acids and 3 perfluorinated alkyl sulfonates were measured in the serum of 242 adults (>18 years old) recruited in 2015 and living in the Province of Liege. Some multivariate regression models were also built with the PFAS levels and the participant's answers to a questionnaire about their diet and lifestyle habits in order to identify some predictors of exposure. The results obtained showed that although PFAS levels observed in our population seemed to be similar or lower than those reported in other countries, and especially lower than in the Northern part of Belgium, half of the population showed PFOS and PFOA serum levels above the health guidance values set by the German HBM Commission. As expected, age and gender were the main covariates explaining the different PFAS serum levels between participants, while breastfeeding (for women), consumption of fish and seafood, consumption of rice, and use of nail polish seemed also to impact the PFAS body burden of our population. Nevertheless, the statistical models were poorly predictive suggesting that the main sources of exposure were not taken into account.
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Affiliation(s)
- Catherine Pirard
- Laboratory of Clinical, Forensic and Environmental Toxicology, CHU of Liege, B35, 4000, Liege, Belgium.
| | - Patrice Dufour
- Laboratory of Clinical, Forensic and Environmental Toxicology, CHU of Liege, B35, 4000, Liege, Belgium
| | - Corinne Charlier
- Laboratory of Clinical, Forensic and Environmental Toxicology, CHU of Liege, B35, 4000, Liege, Belgium
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75
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Moerke MJ, McMahon LR, Wilkerson JL. More than Smoke and Patches: The Quest for Pharmacotherapies to Treat Tobacco Use Disorder. Pharmacol Rev 2020; 72:527-557. [PMID: 32205338 DOI: 10.1124/pr.119.018028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tobacco use is a persistent public health issue. It kills up to half its users and is the cause of nearly 90% of all lung cancers. The main psychoactive component of tobacco is nicotine, primarily responsible for its abuse-related effects. Accordingly, most pharmacotherapies for smoking cessation target nicotinic acetylcholine receptors (nAChRs), nicotine's major site of action in the brain. The goal of the current review is twofold: first, to provide a brief overview of the most commonly used behavioral procedures for evaluating smoking cessation pharmacotherapies and an introduction to pharmacokinetic and pharmacodynamic properties of nicotine important for consideration in the development of new pharmacotherapies; and second, to discuss current and potential future pharmacological interventions aimed at decreasing tobacco use. Attention will focus on the potential for allosteric modulators of nAChRs to offer an improvement over currently approved pharmacotherapies. Additionally, given increasing public concern for the potential health consequences of using electronic nicotine delivery systems, which allow users to inhale aerosolized solutions as an alternative to smoking tobacco, an effort will be made throughout this review to address the implications of this relatively new form of nicotine delivery, specifically as it relates to smoking cessation. SIGNIFICANCE STATEMENT: Despite decades of research that have vastly improved our understanding of nicotine and its effects on the body, only a handful of pharmacotherapies have been successfully developed for use in smoking cessation. Thus, investigation of alternative pharmacological strategies for treating tobacco use disorder remains active; allosteric modulators of nicotinic acetylcholine receptors represent one class of compounds currently under development for this purpose.
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Affiliation(s)
- M J Moerke
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
| | - L R McMahon
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
| | - J L Wilkerson
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
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76
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A review of the effects of tobacco smoking on the treatment of prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Prostate cancer is the most commonly diagnosed malignancy and the third leading cause of death among Canadian men. The standard treatment modalities for prostate cancer include prostatectomy, radiation therapy, hormonal therapy and chemotherapy or any combination depending on the stage of the tumour. However, several studies have reported that tobacco smoking at the time of diagnosis and during treatment can potentially impact treatment efficacy, outcome and patients quality of life after treatment.Materials and methods:This narrative literature review elucidates the impacts of tobacco smoking on prostate cancer progression, treatment efficacy, including its effects on prostatectomy, radiation therapy and chemotherapy, risk of cancer recurrence and mortality and quality of life after treatment. Furthermore, we discuss the importance of integrating a smoking cessation programme into the treatment regimen for prostate cancer patients in order to yield more favourable treatment outcomes, reduce risk of recurrence and mortality and increase the quality of life after treatment for prostate cancer patients.Conclusions:Smoking cessation is one of the most important interventions to prevent cancer and it is also essential after the diagnosis of prostate cancer to improve clinical outcomes. All prostate cancer patients should be advised to quit tobacco use since it can potentially improve treatment response rates and survival, as well as reduce the risk of developing treatment complications and potentially improve the quality of life after treatment. There are several benefits to smoking cessation and it should become an important component of the cancer care continuum in all oncology programmes, starting from prevention of cancer through diagnosis, treatment, survivorship and palliative care. Evidence-based smoking cessation intervention should be sustainably integrated into any comprehensive cancer programme, and the information should be targeted to the specific benefits of cessation in cancer patients.
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77
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Schoretsanitis G, Haen E, Conca A, Piacentino D, Ridders F, Hiemke C, Gründer G, Paulzen M. Lack of Smoking Effects on Pharmacokinetics of Oral Paliperidone-analysis of a Naturalistic Therapeutic Drug Monitoring Sample. PHARMACOPSYCHIATRY 2020; 54:31-35. [PMID: 32767297 DOI: 10.1055/a-1221-5293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Major smoking effects have been reported for a series of psychotropic agents, mainly including substrates of CYP450 1A2, although smoking may also affect alternative metabolic pathways. To our knowledge, smoking effects on paliperidone pharmacokinetics have not been assessed yet. METHODS We compared plasma concentrations of paliperidone as well as dose-corrected-plasma concentrations (C/D) from a naturalistic database between smokers and nonsmokers using nonparametrical tests, such as the Mann-Whitney U-test (MWU). Additionally, we compared light and heavy smokers with nonsmokers separately. RESULTS Comparing 55 smokers with 37 nonsmokers treated with oral paliperidone, no differences in the percentage of females, age, body weight, body mass index, and daily paliperidone dose were reported (p=0.709 for χ2, p=0.26, p=0.38, p=0.67, and p=0.8 for MWU). No differences were detected in plasma concentrations or C/D values (p=0.50 and p=0.96 for MWU). Likewise, differences in daily dose, plasma concentrations, or C/D values were not significant between light smokers (n=17) and nonsmokers (p=0.61, p=0.81, and p=0.33 for MWU) or heavy smokers (n=22) and nonsmokers (p=0.874, p=0.38, and p=0.59; MWU in all cases). DISCUSSION Paliperidone is not affected by smoking, and paliperidone dose-adjustments in smokers may not be necessary. This may be seen as an essential difference to risperidone, whose cytochrome-mediated metabolism might be affected by smoking.
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Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Andreas Conca
- Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, The National Institutes of Health, Bethesda, USA
| | - Florian Ridders
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany, and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
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78
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Kocis PT, Vrana KE. Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Med Cannabis Cannabinoids 2020; 3:61-73. [PMID: 34676340 PMCID: PMC8489344 DOI: 10.1159/000507998] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/19/2020] [Indexed: 08/05/2023] Open
Abstract
Although prescribing information (PI) is often the initial source of information when identifying potential drug-drug interactions, it may only provide a limited number of exemplars or only reference a class of medications without providing any specific medication examples. In the case of medical cannabis and medicinal cannabinoids, this is further complicated by the fact that the increased therapeutic use of marijuana extracts and cannabidiol oil will not have regulatory agency approved PI. The objective of this study was to provide a detailed and comprehensive drug-drug interaction list that is aligned with cannabinoid manufacturer PI. The cannabinoid drug-drug interaction information is listed in this article and online supplementary material as a PRECIPITANT (cannabinoid) medication that either INHIBITS/INDUCES the metabolism or competes for the same SUBSTRATE target (metabolic enzyme) of an OBJECT (OTHER) medication. In addition to a comprehensive list of drug-drug interactions, we also provide a list of 57 prescription medications displaying a narrow therapeutic index that are potentially impacted by concomitant cannabinoid use (whether through prescription use of cannabinoid medications or therapeutic/recreational use of cannabis and its extracts).
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Affiliation(s)
- Paul T. Kocis
- Department of Pharmacy, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kent E. Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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79
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Malhotra P, Akku R, Jayaprakash TP, Ogbue OD, Khan S. A Review of the Impact of Smoking on Inhaled Insulin: Would You Stop Smoking if Insulin Can Be Inhaled? Cureus 2020; 12:e9364. [PMID: 32850233 PMCID: PMC7445000 DOI: 10.7759/cureus.9364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
High prevalence of diabetes and the need for tight glycemic control have been well established. With the invention of inhaled insulin, an alternate route has been explored and shows great promise. Inhaled insulin shows a similar physiologic response to subcutaneous insulin, with a faster onset of action, making it suitable for post-prandial hyperglycemia. This comes as a great relief, especially to those who are hesitant to use multiple injections in a day. Many factors affect insulin absorption, including device, particle size, airway patency. Another essential factor is smoking, which is prevalent among people with diabetes, as is in the non-diabetic population. Smoking increases the absorption of inhaled insulin, but it is not a straight fact, since acute smoking, passive smoking, chronic smoking - all have different effects on inhaled insulin. Furthermore, inhaled insulin is also affected by lung diseases. Most studies that have been conducted have included limited populations, thus questioning their generalisability. The studies from inception till 2020 have shown increased permeability of epithelial with acute smoking, change of epithelial layer back to normal after few weeks of smoking cessation, and reverting to chronic smoker levels with just one to two days of start in smoking. Data also suggests that smoking causes a reduction in insulin sensitivity, which could compensate for its increased absorption. Nicotine causes a decrease in the absorption of subcutaneous insulin, but its effect has not been seen on inhaled insulin. More studies, including diabetic smoker patients, need to be performed to give a specific set of variables. This would also add another reason to encourage smokers to quit smoking.
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Affiliation(s)
- Parul Malhotra
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Punjab Institute of Medical Sciences, Ludhiana, IND
| | - Radhika Akku
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Olisaemeka D Ogbue
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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80
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Tancredi N, Kohli N. Smoking cessation and duloxetine toxicity: A case report. J Am Pharm Assoc (2003) 2020; 60:e117-e120. [PMID: 32094037 DOI: 10.1016/j.japh.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Psychiatric medications are among the drugs affected by cigarette smoke, and because of the high prevalence of smoking in the psychiatric community, psychiatric patients are particularly at risk when entering the smoke-free environment of a hospital. CASE SUMMARY Polycyclic aromatic hydrocarbons present in cigarette smoke are well-known inducers of cytochrome P450 (CYP) enzymes. CYP1A2 induction by cigarette smoking increases metabolic clearance of substrates of this enzyme; smoking cessation results in a decrease in CYP1A2 activity, which causes an increase in serum substrate levels. Although these effects are well documented, the effect of smoking cessation remains a hidden danger, in part, because computerized drug interaction surveillance systems are not designed to alert clinicians when an offending agent is discontinued. PRACTICE IMPLICATION To raise awareness and demonstrate the importance of a thorough assessment of smoking status, we present a case in which the temporal relationship of smoking cessation to the emergence of nausea, vomiting, and tachycardia 3 days later (day 3); the development of myoclonic jerks by day 5; and the resolution of symptoms on reduction of duloxetine dosage on day 44 implicates duloxetine toxicity in a patient with ischemic cardiomyopathy awaiting implantation of a left ventricular assist device.
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81
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A Systematic Review of the Relative Frequency and Risk Factors for Prolonged Opioid Prescription Following Surgery and Trauma Among Adults. Ann Surg 2020; 271:845-854. [PMID: 31188226 DOI: 10.1097/sla.0000000000003403] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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82
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Kabir MT, Uddin MS, Begum MM, Thangapandiyan S, Rahman MS, Aleya L, Mathew B, Ahmed M, Barreto GE, Ashraf GM. Cholinesterase Inhibitors for Alzheimer's Disease: Multitargeting Strategy Based on Anti-Alzheimer's Drugs Repositioning. Curr Pharm Des 2020; 25:3519-3535. [PMID: 31593530 DOI: 10.2174/1381612825666191008103141] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
In the brain, acetylcholine (ACh) is regarded as one of the major neurotransmitters. During the advancement of Alzheimer's disease (AD) cholinergic deficits occur and this can lead to extensive cognitive dysfunction and decline. Acetylcholinesterase (AChE) remains a highly feasible target for the symptomatic improvement of AD. Acetylcholinesterase (AChE) remains a highly viable target for the symptomatic improvement in AD because cholinergic deficit is a consistent and early finding in AD. The treatment approach of inhibiting peripheral AChE for myasthenia gravis had effectively proven that AChE inhibition was a reachable therapeutic target. Subsequently tacrine, donepezil, rivastigmine, and galantamine were developed and approved for the symptomatic treatment of AD. Since then, multiple cholinesterase inhibitors (ChEIs) have been continued to be developed. These include newer ChEIs, naturally derived ChEIs, hybrids, and synthetic analogues. In this paper, we summarize the different types of ChEIs which are under development and their respective mechanisms of actions.
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Affiliation(s)
| | - Md Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh.,Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
| | | | | | - Md Sohanur Rahman
- Graduate School of Innovative Life Science, University of Toyama, Toyama, Japan
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Bijo Mathew
- Division of Drug Design and Medicinal Chemistry Research Lab, Department of Pharmaceutical Chemistry, Ahalia School of Pharmacy, Palakkad, India
| | - Muniruddin Ahmed
- Department of Pharmacy, Daffodil International University, Dhaka, Bangladesh
| | - George E Barreto
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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83
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Stoops S, Kovac A. New insights into the pathophysiology and risk factors for PONV. Best Pract Res Clin Anaesthesiol 2020; 34:667-679. [PMID: 33288117 DOI: 10.1016/j.bpa.2020.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Postoperative nausea and vomiting (PONV) affects patient outcomes and satisfaction. New research has centered on evaluation of post-discharge and opioid-related nausea and vomiting. Mechanical and drug effects stimulate the release of central nervous system neurotransmitters acting at receptors in the vomiting center, area postrema, and nucleus of the solitary tract. Brain surgery has allowed insight into specific central emetogenic areas. Stimuli from peripheral organs act through afferent vagus neurons and a parasympathetic response causing nausea and vomiting. Opioids stimulate mu receptors in the chemoreceptor trigger zone and cholinergic receptors in the vestibular system. Opioids also affect gastrointestinal (GI) tract mechanics by decreasing gastric emptying, intestinal motility, GI peristalsis, and secretions. Regional blocks and non-opioid multimodal analgesia help to decrease nausea and vomiting. Patient, surgery, and anesthesia factors contribute to risk and degree of PONV experienced. Pharmacogenetics plays a role in gene typing as antiemetic medication metabolism results in varying drug effectiveness. Risk scoring systems are available. Individualized multimodal plans can be designed as part of an enhanced recovery after surgery protocol.
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Affiliation(s)
- Shea Stoops
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1034, Kansas City, KS 66160, USA.
| | - Anthony Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1034, Kansas City, KS 66160, USA.
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84
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Evangelista EA, Cho CW, Aliwarga T, Totah RA. Expression and Function of Eicosanoid-Producing Cytochrome P450 Enzymes in Solid Tumors. Front Pharmacol 2020; 11:828. [PMID: 32581794 PMCID: PMC7295938 DOI: 10.3389/fphar.2020.00828] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
Oxylipins derived from the oxidation of polyunsaturated fatty acids (PUFAs) act as important paracrine and autocrine signaling molecules. A subclass of oxylipins, the eicosanoids, have a broad range of physiological outcomes in inflammation, the immune response, cardiovascular homeostasis, and cell growth regulation. Consequently, eicosanoids are implicated in the pathophysiology of various diseases, most notably cancer, where eicosanoid mediated signaling is involved in tumor development, progression, and angiogenesis. Cytochrome P450s (CYPs) are a superfamily of heme monooxygenases generally involved in the clearance of xenobiotics while a subset of isozymes oxidize PUFAs to eicosanoids. Several eicosanoid forming CYPs are overexpressed in tumors, elevating eicosanoid levels and suggesting a key function in tumorigenesis and progression of tumors in the lung, breast, prostate, and kidney. This review summarizes the current understanding of CYPs' involvement in solid tumor etiology and progression providing supporting public data for gene expression from The Cancer Genome Atlas.
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Affiliation(s)
- Eric A Evangelista
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Christi W Cho
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Theresa Aliwarga
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Rheem A Totah
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA, United States
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Scheidl E, Benz C, Loeff P, Groneck V, König A, Schulte-Fischedick A, Lück H, Fuhr U. Frequency and Types of Pathological Upper Gastrointestinal Endoscopy Findings in Clinically Healthy Individuals. Drugs R D 2020; 20:115-124. [PMID: 32335854 PMCID: PMC7221033 DOI: 10.1007/s40268-020-00303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Beyond its application for diagnostics in patients, esophagogastroduodenoscopy (EGD) is used to assess gastrointestinal drug effects in clinical trials, where the interpretation of any pathological findings depends on the respective background variability. The objective of this analysis was to characterize the occurrence of pathological findings in the upper gastrointestinal tract in symptom-free healthy individuals. METHODS A baseline EGD was performed in clinically healthy individuals in three clinical trials aimed to assess gastrointestinal tolerability of drugs. Pathological findings were described by type (redness, erosion, ulcer or other), number, size and location, and by clinical relevance as assessed by the endoscopist. Characteristics of volunteers were tested as potential covariates. RESULTS A total of 294 EGDs were assessed. Characteristics of individuals were as follows: 257 (87.4%) males, age (mean ± SD) 32.0 ± 8.1 years, body weight 76.0 ± 10.6 kg, body mass index (BMI) 24.0 ± 2.5 kg/m2, 200 consumed alcohol, 250 (of 290 where this information was available) consumed caffeine and 39 (of 152) were smokers, 30 (of 151) tested positive for H. pylori. Any pathological finding was present in 79.6%. Clinically relevant findings occurred in 44.2%, mainly erosions (39.1%). Nine stomach ulcers were observed. Only age and BMI had a statistically significant relationship to overall pathological findings [age 3.4 years higher (p = 0.027), and BMI 1.6 kg/m2 higher (p < 0.001); for clinically relevant vs no findings]. CONCLUSION Upper gastrointestinal tract mucosal lesions, including those assessed as clinically relevant, are frequent in clinically healthy individuals, impeding the assessment of causality for both disease and drug effects on gastrointestinal health.
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Affiliation(s)
- Elisabeth Scheidl
- Clinical Pharmacology Unit, Department I of Pharmacology, Center for Pharmacology, University Hospital Cologne (AöR), Gleueler Straße 24, 50931, Köln, Germany
- ITECRA GmbH & Co. KG, Köln, Germany
| | - Claus Benz
- Department of Gastroenterology, Ev. Krankenhaus Köln-Weyertal, Köln, Germany
| | - Peter Loeff
- Department of Gastroenterology, Ev. Krankenhaus Köln-Weyertal, Köln, Germany
| | - Volker Groneck
- Department of Gastroenterology, Ev. Krankenhaus Köln-Weyertal, Köln, Germany
| | - Andreas König
- Department of Gastroenterology, Ev. Krankenhaus Köln-Weyertal, Köln, Germany
| | | | | | - Uwe Fuhr
- Clinical Pharmacology Unit, Department I of Pharmacology, Center for Pharmacology, University Hospital Cologne (AöR), Gleueler Straße 24, 50931, Köln, Germany.
- ITECRA GmbH & Co. KG, Köln, Germany.
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86
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Yu EYW, Dai Y, Wesselius A, van Osch F, Brinkman M, van den Brandt P, Grant EJ, White E, Weiderpass E, Gunter M, Hemon B, Zeegers MP. Coffee consumption and risk of bladder cancer: a pooled analysis of 501,604 participants from 12 cohort studies in the BLadder Cancer Epidemiology and Nutritional Determinants (BLEND) international study. Eur J Epidemiol 2020; 35:523-535. [PMID: 31927701 DOI: 10.1007/s10654-019-00597-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023]
Abstract
Recent epidemiological studies have shown varying associations between coffee consumption and bladder cancer (BC). This research aims to elucidate the association between coffee consumption and BC risk by bringing together worldwide cohort studies on this topic. Coffee consumption in relation to BC risk was examined by pooling individual data from 12 cohort studies, comprising of 2601 cases out of 501,604 participants. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were obtained using multilevel Weibull regression models. Furthermore, dose-response relationships were examined using generalized least squares regression models. The association between coffee consumption and BC risk showed interaction with sex (P-interaction < 0.001) and smoking (P-interaction = 0.001). Therefore, analyses were stratified by sex and smoking. After adjustment for potential confounders, an increased BC risk was shown for high (> 500 ml/day, equivalent to > 4 cups/day) coffee consumption compared to never consumers among male smokers (current smokers: HR = 1.75, 95% CI 1.27-2.42, P-trend = 0.002; former smokers: HR = 1.44, 95% CI 1.12-1.85, P-trend = 0.001). In addition, dose-response analyses, in male smokers also showed an increased BC risk for coffee consumption of more than 500 ml/day (4 cups/day), with the risk of one cup (125 ml) increment as 1.07 (95% CI 1.06-1.08). This research suggests that positive associations between coffee consumption and BC among male smokers but not never smokers and females. The inconsistent results between sexes and the absence of an association in never smokers indicate that the associations found among male smokers is unlikely to be causal and is possibly caused by residual confounding of smoking.
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Affiliation(s)
- Evan Y W Yu
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands
| | - Yanan Dai
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands.
| | - Frits van Osch
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands
| | - Maree Brinkman
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands
- Department of Clinical Studies and Nutritional Epidemiology, Nutrition Biomed Research Institute, Melbourne, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Piet van den Brandt
- Department of Epidemiology, Schools for Oncology and Developmental Biology and Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eric J Grant
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Emily White
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elisabete Weiderpass
- International Agency for Research on Cancer World Health Organization, Lyon, France
| | - Marc Gunter
- International Agency for Research on Cancer World Health Organization, Lyon, France
| | - Bertrand Hemon
- International Agency for Research on Cancer World Health Organization, Lyon, France
| | - Maurice P Zeegers
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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Abstract
To date, many questions about the extent and cause of pharmacokinetic (PK) variability of even the most widely studied and prescribed β1-adrenergic receptor blockers, such as metoprolol and bisoprolol, remain unanswered. Given that there are still no published population pharmacokinetic (PopPK) analyses of bisoprolol in routinely treated patients with acute coronary syndrome (ACS), the aim of this study was to determine its PK variability in 71 Serbian patients with ACS. PopPK analysis was conducted using a nonlinear mixed-effects model (NONMEM), version 7.3.0 (Icon Development Solutions). In each patient, the same formulation of bisoprolol was administered once or twice daily at a total daily dose of 0.625-7.5 mg. We separately assessed the effects of 31 covariates on the PKs of bisoprolol, and our results indicated that only 2 covariates could have possible influence on the variability of the clearance of bisoprolol: the mean daily dose of the drug and smoking habits of patients. These findings suggest that possible autoinduction of drug metabolism by higher total daily doses and induction of cytochrome P450 isoform 3A4 (CYP3A4) by cigarette smoke in liver could be the potential causes of increased total clearance of bisoprolol in patients with ACS.
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88
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Perlík F. Impact of smoking on metabolic changes and effectiveness of drugs used for lung cancer. Cent Eur J Public Health 2020; 28:53-58. [PMID: 32228818 DOI: 10.21101/cejph.a5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/17/2019] [Indexed: 11/15/2022]
Affiliation(s)
- František Perlík
- Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Institute for Postgraduate Medical Education, Prague, Czech Republic
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89
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Reduction in N-Desmethylclozapine Level Is Determined by Daily Dose But Not Serum Concentration of Valproic Acid-Indications of a Presystemic Interaction Mechanism. Ther Drug Monit 2020; 41:503-508. [PMID: 31259880 DOI: 10.1097/ftd.0000000000000619] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Valproic acid (VPA) is frequently used together with clozapine (CLZ) as mood-stabilizer or for the prevention of seizures in patients with psychotic disorders. VPA is known to reduce levels of the pharmacologically active CLZ-metabolite N-desmethylclozapine (N-DMC), but factors determining the degree of this interaction are unknown. Here, we investigated the relationship between VPA dose and serum concentration on N-DMC levels in a large patient population adjusting for sex, age, and smoking habits as covariates. METHODS A total of 763 patients with steady-state serum concentrations of CLZ and N-DMC concurrently using VPA (cases, n = 76) or no interacting drugs (controls, n = 687) were retrospectively included from a therapeutic drug monitoring service at Diakonhjemmet Hospital, Oslo, between March 2005 and December 2016. In addition to information about prescribed doses, age, sex, smoking habits, and use of other interacting drugs were obtained. The effects of VPA dose and serum concentration on dose-adjusted N-DMC levels were evaluated by univariate correlation and multivariate linear mixed-model analyses adjusting for covariates. RESULTS The dose-adjusted N-DMC levels were approximately 38% lower in VPA users (cases) versus nonusers (controls) (P < 0.001). Within the VPA cases, a negatively correlation between VPA dose and dose-adjusted N-DMC levels was observed with an estimated reduction of 1.42% per 100-mg VPA dose (P = 0.033) after adjusting for sex, age, and smoking. By contrast, there was no correlation between VPA serum concentration and dose-adjusted N-DMC levels (P = 0.873). CONCLUSIONS The study shows that VPA dose, not concentration, is of relevance for the degree of reduction in N-DMC level in clozapine-treated patients. Presystemic induction of UGT enzymes or efflux transporters might underlie the reduction in N-DMC level during concurrent use of VPA. Our findings indicate that a VPA daily dose of 1500 mg or higher provides a further 21% reduction in N-DMC concentration. This is likely a relevant change in the exposure of this active metabolite where low levels are associated with implications of CLZ therapy.
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90
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Abstract
BACKGROUND Tobacco smoking rates in depressive patients are higher compared with the general population. Smoking was demonstrated to accelerate the metabolism of different drugs metabolized by CYP1A2, but possibly also by CYP2C19 and CYP3A4. The principle aim of the present investigation from 2015 to 2018 was to determine the differences in the pharmacokinetics of escitalopram between smokers and nonsmokers. METHODS A group of nonsmokers (n = 88) was compared with smokers (n = 36), both receiving escitalopram, using the Mann-Whitney U test. Linear regression analysis was used to account for the impact of escitalopram dose, age, and sex in addition to smoking on the steady-state serum concentration of escitalopram. RESULTS Smokers received by mean 17.6% higher doses of escitalopram (P = 0.026) but showed 31.9% lower serum concentrations (P = 0.031). To control for confounders, linear regression analysis showed that dose (P < 0.001), sex (P = 0.03), and smoking tobacco (P = 0.027) did significantly influence serum concentrations of escitalopram with higher levels in women and nonsmokers. CONCLUSIONS Notwithstanding higher daily doses, smokers had significantly lower serum concentrations of escitalopram. In concordance with previous results, besides CYP1A2, a possible induction of CYP2C19 and CYP3A4 by tobacco smoke, resulting in lower serum concentrations of escitalopram in smokers than in nonsmokers, is suggested. Therefore, to provide personalized therapy, clinicians should consider smoking status and inform patients on the interactions of smoking and escitalopram metabolism.
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91
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Turner RM, Fontana V, FitzGerald R, Morris AP, Pirmohamed M. Investigating the clinical factors and comedications associated with circulating levels of atorvastatin and its major metabolites in secondary prevention. Br J Clin Pharmacol 2020; 86:62-74. [PMID: 31656041 PMCID: PMC6983514 DOI: 10.1111/bcp.14133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/28/2022] Open
Abstract
Aims The lipid-lowering drug, atorvastatin (ATV), is 1 of the most commonly prescribed medications worldwide. The aim of this study was to comprehensively investigate and characterise the clinical factors and comedications associated with circulating levels of ATV and its metabolites in secondary prevention clinical practice. Methods The plasma concentrations of ATV, 2-hydroxy (2-OH) ATV, ATV lactone (ATV L) and 2-OH ATV L were determined in patients 1 month after hospitalisation for a non-ST elevation acute coronary syndrome. Factors were identified using all subsets multivariable regression and model averaging with the Bayesian information criterion. Exploratory genotype-stratified analyses were conducted using ABCG2 rs2231142 (Q141K) and CYP2C19 metaboliser status to further investigate novel associations. Results A total of 571 patients were included; 534 and 37 were taking ATV 80 mg and 40 mg daily, respectively. Clinical factors associated with ATV and/or its metabolite levels included age, sex, body mass index and CYP3A inhibiting comedications. Smoking was newly associated with increased ATV lactonisation and reduced hydroxylation. Proton pump inhibitors (PPIs) and loop diuretics were newly associated with modestly increased levels of ATV (14% and 38%, respectively) and its metabolites. An interaction between PPIs and CYP2C19 metaboliser status on exposure to specific ATV analytes (e.g. interaction P = .0071 for 2-OH ATV L) was observed. Overall model R2 values were 0.14-0.24.ConclusionMultiple factors were associated with circulating ATV and metabolite levels, including novel associations with smoking and drug-drug(-gene) interactions involving PPIs and loop diuretics. Further investigations are needed to identify additional factors that influence ATV exposure.
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Affiliation(s)
- Richard M Turner
- Department of Molecular & Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Vanessa Fontana
- Department of Molecular & Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Richard FitzGerald
- Department of Molecular & Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Andrew P Morris
- Department of Biostatistics, University of Liverpool, United Kingdom
| | - Munir Pirmohamed
- Department of Molecular & Clinical Pharmacology, University of Liverpool, United Kingdom
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Tidey JW, Colby SM, Denlinger-Apte RL, Goodwin C, Cioe PA, Cassidy RN, Swift RM, Lindgren BR, Rubin N, Murphy SE, Hecht SS, Hatsukami DK, Donny EC. Effects of 6-Week Use of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness. Nicotine Tob Res 2019; 21:S38-S45. [PMID: 31867650 PMCID: PMC6939771 DOI: 10.1093/ntr/ntz133] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The US Food and Drug Administration is considering implementing a reduced-nicotine standard for cigarettes. Given the high rate of smoking among people with serious mental illness (SMI), it is important to examine the responses of these smokers to very low nicotine content (VLNC) cigarettes. METHODS This trial compared the effects of VLNC (0.4 mg nicotine/g tobacco) and normal nicotine content cigarettes (15.8 mg/g) over a 6-week period in non-treatment-seeking smokers with schizophrenia, schizoaffective disorder, or bipolar disorder (n = 58). Linear regression was used to examine the effects of cigarette condition on cigarettes per day, subjective responses, nicotine and tobacco toxicant exposure, craving, withdrawal symptoms, and psychiatric symptoms. RESULTS At week 6, participants in the VLNC condition smoked fewer cigarettes per day, had lower breath carbon monoxide levels, lower craving scores, and rated their study cigarettes lower in satisfaction, reward, enjoyment, and craving reduction than those in the normal nicotine content condition (ps < .05). Week 6 psychiatric and extrapyramidal symptoms did not differ by condition, except for scores on a measure of parkinsonism, which were lower in the VLNC condition (p < .05). There were no differences across conditions on total nicotine exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, withdrawal symptoms, or responses to abstinence. CONCLUSIONS These results suggest that a reduced-nicotine standard for cigarettes would reduce smoking among smokers with SMI. However, the lack of effect on total nicotine exposure indicates VLNC noncompliance, suggesting that smokers with SMI may respond to a reduced-nicotine standard by substituting alternative forms of nicotine. IMPLICATIONS Results from this trial suggest that a reduced-nicotine standard for cigarettes would reduce smoking rates and smoke exposure in smokers with SMI, without increasing psychiatric symptoms. However, noncompliance with VLNC cigarettes was observed, suggesting that these smokers might respond to a reduced-nicotine standard by substituting alternative forms of nicotine.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel L Denlinger-Apte
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Christine Goodwin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Robert M Swift
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | | | - Nathan Rubin
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
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Ghura S, Gross R, Jordan-Sciutto K, Dubroff J, Schnoll R, Collman RG, Ashare RL. Bidirectional Associations among Nicotine and Tobacco Smoke, NeuroHIV, and Antiretroviral Therapy. J Neuroimmune Pharmacol 2019; 15:694-714. [PMID: 31834620 DOI: 10.1007/s11481-019-09897-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Abstract
People living with HIV (PLWH) in the antiretroviral therapy (ART) era may lose more life-years to tobacco use than to HIV. Yet, smoking rates are more than twice as high among PLWH than the general population, contributing not just to mortality but to other adverse health outcomes, including neurocognitive deficits (neuroHIV). There is growing evidence that synergy with chronic inflammation and immune dysregulation that persists despite ART may be one mechanism by which tobacco smoking contributes to neuroHIV. This review will summarize the differential effects of nicotine vs tobacco smoking on inflammation in addition to the effects of tobacco smoke components on HIV disease progression. We will also discuss biomarkers of inflammation via neuroimaging as well as biomarkers of nicotine dependence (e.g., nicotine metabolite ratio). Tobacco smoking and nicotine may impact ART drug metabolism and conversely, certain ARTs may impact nicotine metabolism. Thus, we will review these bidirectional relationships and how they may contribute to neuroHIV and other adverse outcomes. We will also discuss the effects of tobacco use on the interaction between peripheral organs (lungs, heart, kidney) and subsequent CNS function in the context of HIV. Lastly, given the dramatic rise in the use of electronic nicotine delivery systems, we will discuss the implications of vaping on these processes. Despite the growing recognition of the importance of addressing tobacco use among PLWH, more research is necessary at both the preclinical and clinical level to disentangle the potentially synergistic effects of tobacco use, nicotine, HIV, cognition and immune dysregulation, as well as identify optimal approaches to reduce tobacco use. Graphical Abstract Proposed model of the relationships among HIV, ART, smoking, inflammation, and neurocognition. Solid lines represent relationships supported by evidence. Dashed lines represent relationships for which there is not enough evidence to make a conclusion. (a) HIV infection produces elevated levels of inflammation even among virally suppressed individuals. (b) HIV is associated with deficits in cognition function. (c) Smoking rates are higher among PLWH, compared to the general population. (d) The nicotine metabolite ratio (NMR) is associated with smoking behavior. (e) HIV and tobacco use are both associated with higher rates of psychiatric comorbidities, such as depression, and elevated levels of chronic stress. These factors may represent other mechanisms linking HIV and tobacco use. (f) The relationship between nicotine, tobacco smoking, and inflammation is complex, but it is well-established that smoking induces inflammation; the evidence for nicotine as anti-inflammatory is supported in some studies, but not others. (g) The relationship between tobacco use and neurocognition may differ for the effects of nicotine (acute nicotine use may have beneficial effects) vs. tobacco smoking (chronic use may impair cognition). (h) Elevated levels of inflammation may be associated with deficits in cognition. (i) PLWH may metabolize nicotine faster than those without HIV; the mechanism is not yet known and the finding needs validation in larger samples. We also hypothesize that if HIV-infection increases nicotine metabolism, then we should observe an attenuation effect once ART is initiated. (j) It is possible that the increase in NMR is due to ART effects on CYP2A6. (k) We hypothesize that faster nicotine metabolism may result in higher levels of inflammation since nicotine has anti-inflammatory properties.
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Affiliation(s)
- Shivesh Ghura
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Jordan-Sciutto
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Dubroff
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA.
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Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SMI, Dzaye O, El Shahawy O, Al Rifai M, Bhatnagar A, Stokes A, Benjamin EJ, DeFilippis AP, Blaha MJ. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Netw Open 2019; 2:e1916800. [PMID: 31800073 PMCID: PMC6902792 DOI: 10.1001/jamanetworkopen.2019.16800] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. OBJECTIVE To examine the association between e-cigarette use and depression in a nationally representative sample of the adult population in the United States. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the Behavioral Risk Factor Surveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892 394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019. EXPOSURES Electronic cigarette use status defined by self-report as never, former, or current use. MAIN OUTCOMES AND MEASURES Self-reported history of a clinical diagnosis of depression. RESULTS Of the 892 394 participants (414 326 [29.0%] aged ≥60 years; 502 448 [51.3%] women), there were 28 736 (4.4%) current e-cigarette users, of whom 13 071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120 797 [24.3%] vs 10 517 [48.4%]; men, 318 970 [46.6%] vs 14 962 [60.1%]; aged 18-39 years, 129 085 [32.2%] vs 13 071 [62.1%]; current combustible cigarette use, 217 895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. CONCLUSIONS AND RELEVANCE This study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Albert D. Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. M. Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Omar El Shahawy
- Section on Tobacco, Alcohol, and Drug Use, Department of Population Health, School of Medicine, New York University, New York
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
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Richard F, Creusot T, Catoire S, Egles C, Ficheux H. Mechanisms of pollutant-induced toxicity in skin and detoxification: Anti-pollution strategies and perspectives for cosmetic products. ANNALES PHARMACEUTIQUES FRANÇAISES 2019; 77:446-459. [DOI: 10.1016/j.pharma.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 10/25/2022]
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96
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Caffeine Restrictions in Inpatient Psychiatric Settings: Precipitating Withdrawal? J Addict Med 2019; 14:269-271. [PMID: 31609867 DOI: 10.1097/adm.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Caffeine is often restricted in locked inpatient psychiatric facilities based on concern that it may exacerbate clinical symptoms. However, psychiatric inpatients may be at particularly high risk of caffeine withdrawal during psychiatric hospitalization, which may cause undue discomfort or distress, limit their engagement in inpatient treatment, and confound the management of psychiatric illness. Psychiatric patients who regularly consume caffeine also possess a degree of caffeine tolerance which may reduce the risk of adverse effects associated with continued inpatient caffeine intake. For these reasons, it appears reasonable to allow caffeine in inpatient psychiatric settings.
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97
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Usabiaga I, Camiruaga A, Calabrese C, Maris A, Fernández JA. Exploring Caffeine–Phenol Interactions by the Inseparable Duet of Experimental and Theoretical Data. Chemistry 2019; 25:14230-14236. [DOI: 10.1002/chem.201903478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Imanol Usabiaga
- Department of Physical ChemistryUniversity of the Basque Country (UPV/EHU) Barrio Sarriena, S/N 48940 Leioa Spain
- Dipartimento di Chimica “Giacomo Ciamician”Università di Bologna via Selmi 2 40126 Bologna Italy
| | - Ander Camiruaga
- Department of Physical ChemistryUniversity of the Basque Country (UPV/EHU) Barrio Sarriena, S/N 48940 Leioa Spain
| | - Camilla Calabrese
- Department of Physical ChemistryUniversity of the Basque Country (UPV/EHU) Barrio Sarriena, S/N 48940 Leioa Spain
- Instituto Biofisika (UPV/EHU, CSIC)University of the Basque Country Leioa E-48080 Spain
| | - Assimo Maris
- Dipartimento di Chimica “Giacomo Ciamician”Università di Bologna via Selmi 2 40126 Bologna Italy
| | - José A. Fernández
- Department of Physical ChemistryUniversity of the Basque Country (UPV/EHU) Barrio Sarriena, S/N 48940 Leioa Spain
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98
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Moon SJ, Jeon JY, Yu KS, Kim MG. Pharmacokinetic Interaction Among Telmisartan, Amlodipine, and Hydrochlorothiazide After a Single Oral Administration in Healthy Male Subjects. Clin Ther 2019; 41:2273-2282. [PMID: 31564513 DOI: 10.1016/j.clinthera.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Hypertension is a major risk factor for cardiovascular diseases, necessitating hypertension control. Antihypertensive drugs are more potent when administered in combinations of 2 or 3 different classes of drugs. One such therapy includes a combination of an angiotensin receptor blocker, a calcium channel blocker, and a diuretic. The objective of this study was to evaluate the pharmacokinetic interaction among telmisartan, amlodipine, and hydrochlorothiazide. METHODS A randomized, open-label, 3-period, 6-sequence, 3-treatment, single-dose crossover study was conducted in healthy male subjects. Subjects were randomly assigned to 1 of 6 sequences and one of the following treatments was administered in each period: treatment A, co-administration of one tablet of telmisartan 80 mg and one tablet of amlodipine 10 mg; treatment B, one tablet of hydrochlorothiazide 25 mg alone; and treatment C, co-administration of all 3 investigational products. Serial blood samples were collected up to 144 hours postdose. Plasma drug concentrations were measured by using LC/MS-MS. Pharmacokinetic parameters, including Cmax and AUC0-last, were determined by using noncompartmental analysis. The geometric least squares mean ratios and associated 90% CIs of log-transformed Cmax and AUC0-last for separate administration or co-administration were calculated to evaluate pharmacokinetic interactions. FINDINGS Twenty-seven subjects completed the study. The geometric least squares mean ratios and 90% CIs of Cmax and AUC0-last were 1.02 (0.85-1.21) and 1.04 (0.97-1.13) for telmisartan; 1.00 (0.95-1.04) and 0.95 (0.91-0.99) for amlodipine; and 0.88 (0.82-0.96) and 0.86 (0.82-0.90) for hydrochlorothiazide, respectively. No serious adverse events were recorded, and all reported adverse events were of mild intensity. IMPLICATIONS The pharmacokinetic parameters of telmisartan, amlodipine, and hydrochlorothiazide when administered separately or co-administered were compared, and all the parameters met the criteria for pharmacokinetic equivalence. Combination therapy of these 3 drugs had no significant impact on the pharmacokinetic parameters of each drug. (ClinicalTrials.gov Identifier: NCT03889145).
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Affiliation(s)
- Seol Ju Moon
- Center for Clinical Pharmacology and Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea; Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Ji-Young Jeon
- Center for Clinical Pharmacology and Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Min-Gul Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Republic of Korea; Department of Pharmacology, School of Medicine, Chonbuk National University, Jeonju, Republic of Korea.
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99
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Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: Nicotine addiction. SCIENCE ADVANCES 2019; 5:eaay9763. [PMID: 31663029 PMCID: PMC6795520 DOI: 10.1126/sciadv.aay9763] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/26/2019] [Indexed: 05/05/2023]
Abstract
The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.
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Affiliation(s)
- Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Neal L. Benowitz
- Program in Clinical Pharmacology, Division of Cardiology, and the Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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100
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Augustin M, Schoretsanitis G, Pfeifer P, Gründer G, Liebe C, Paulzen M. Effect of fluvoxamine augmentation and smoking on clozapine serum concentrations. Schizophr Res 2019; 210:143-148. [PMID: 31182321 DOI: 10.1016/j.schres.2019.05.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/18/2019] [Accepted: 05/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clozapine (CLZ) is metabolized via cytochrome P450 CYP1A2 to N-desmethylclozapine (NCLZ). Smoking induces CYP1A2 thereby increasing clozapine metabolism whereas fluvoxamine inhibits CYP1A2. Studies suggest that the beneficial effect of fluvoxamine augmentation in raising serum clozapine concentrations also occurs when serum concentrations are low due to smoking. Yet, little is known about the influence of fluvoxamine augmentation on clozapine serum concentrations in smoking versus non-smoking patients. METHODS A TDM database was analyzed. Serum concentrations of CLZ, NCLZ, dose-adjusted serum concentrations (C/D) and metabolite-to-parent ratios (MPR) were compared using non-parametrical tests in four groups: clozapine-monotherapy in non-smokers (VNS, n = 28) and smokers (VS, n = 43); combined treatment with clozapine and fluvoxamine in non-smokers (VNS+F, n = 11) and smokers (VS+F, n = 43). RESULTS The CLZ monotherapy smoking group showed lower values of C/D CLZ of -38.6% (p < 0.001), C/D NCLZ -35.6% (p < 0.001) and a higher MPR (p = 0.021) than in the non-smoking group. The combination of CLZ and fluvoxamine in non-smoking patients led to higher C/D values: C/D CLZ +117.9% (p < 0.001), C/D NCLZ +60.8% (p = 0.029) while the MPR did not differ between groups (p = 0.089). Changes were comparable to fluvoxamine augmentation in the smoking group with increased C/D CLZ of +120.1% (p < 0.001), C/D NCLZ of +85.8% (p < 0.001) and lower MPR (p = 0.006). CONCLUSIONS Smoking in clozapine monotherapy reduced median dose-adjusted serum concentrations more than a third. Combined treatment with fluvoxamine and clozapine led to higher median C/D values in both, smokers and non-smokers. The opposing effects of CYP1A2 induction by smoking and inhibition by fluvoxamine on clozapine serum concentrations balanced out.
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Affiliation(s)
- Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany.
| | - Georgios Schoretsanitis
- University Hospital of Psychiatry, Bern, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hempstead, New York and The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Philippe Pfeifer
- University Hospital of Psychiatry Bern, University of Bern, Bern, Switzerland
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Aachen, Germany
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