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Zeki NM, Mustafa YF. Natural linear coumarin-heterocyclic conjugates: A review of their roles in phytotherapy. Fitoterapia 2024; 175:105929. [PMID: 38548026 DOI: 10.1016/j.fitote.2024.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 05/26/2024]
Abstract
Heterocycle conjugates provide a fresh investigative scope to find novel molecules with enhanced phytotherapeutic characteristics. Coumarin-based products are widely used in the synthesis of several compounds with biological and medicinal properties since they are naturally occurring heterocycles with a broad dispersion. The investigation of coumarin-based phytochemicals with annulated heterocyclic rings is a promising approach to discovering novel conjugates with significant phytotherapeutic attributes. Due to the applicable coumarin extraction processes, a range of linear coumarin-heterocyclic conjugates were isolated from different natural resources and exhibited remarkable therapeutic efficacy. This review highlights the phytotherapeutic potential and origins of various natural linear coumarin-heterocyclic conjugates. We searched several databases, including Science Direct, Web of Science, Springer, Google Scholar, and PubMed. After sieving, we ultimately identified and included 118 pertinent studies published between 2000 and the middle of 2023. This will inspire medicinal chemists with extremely insightful ideas for designing and synthesizing therapeutically active lead compounds in the future that are built on the pharmacophores of coumarin-heterocyclic conjugates and have significant therapeutic attributes.
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Affiliation(s)
- Nameer Mazin Zeki
- Department of Pharmacology, College of Medicine, Ninevah University, Mosul, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul, Iraq.
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2
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Leyva-López N, Gutiérrez-Grijalva EP, Heredia JB, Ramos-Payan R, Contreras-Angulo LA, Gonzalez-Galaviz JR, Rodriguez-Anaya LZ. Antioxidant potential, cytokines regulation, and inflammation-related genes expression of phenolic extracts from Mexican oregano. J Food Biochem 2022; 46:e14440. [PMID: 36169085 DOI: 10.1111/jfbc.14440] [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: 07/29/2022] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 01/14/2023]
Abstract
The Mexican population traditionally uses oregano infusions to treat oxidative and inflammation-related disorders. Therefore, this study was focused on the examination of the antioxidant capacity and potential against inflammation from three Mexican oregano species (Lippia graveolens [LG], Lippia palmeri [LP], and Hedeoma patens [HP]). The extracts from LG showed a superior total phenolic content. LG, LP, and HP exhibited a higher capacity to inhibit the radical DPPH (up to 90.33 ± 0.25%) and significantly lowered the release of MCP-1 and IL-6. At the same time, LG and HP increased the secretion of IL-10. Extracts from LG, LP, and HP did not significantly diminish the expression of il-1β or inos, although a slight decrease in inos expression was observed. Our findings support that phenolic extracts from L. graveolens, L. palmeri, and H. patens possess antioxidant and anti-inflammatory properties and might be potential therapeutic candidates against oxidative and inflammation-related diseases. PRACTICAL APPLICATIONS: Oregano species have traditionally been exploited as remedies against inflammatory-related diseases, namely headaches, asthma, bowel disorders, and rheumatism. This study explored the antioxidant potential of three Mexican oregano species (Lippia graveolens, Lippia palmeri, and Hedeoma patens) and their anti-inflammatory effects in a murine cell model. Phenolic extracts from oregano showed antioxidant capacity and exerted activity against inflammation by improving anti-inflammatory cytokines secretion or negatively regulating pro-inflammatory cytokines. The results of our study demonstrate that the phenolic extracts from these Mexican oregano species have the potential in treating inflammation-related diseases.
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Affiliation(s)
- Nayely Leyva-López
- Centro de Investigación en Alimentación y Desarrollo, A.C., Culiacán, Mexico
| | - Erick P Gutiérrez-Grijalva
- Laboratory of Functional Foods and Nutraceuticals, Cátedras CONACYT-Centro de Investigación en Alimentación y Desarrollo, A.C., Culiacán, Mexico
| | - J Basilio Heredia
- Centro de Investigación en Alimentación y Desarrollo, A.C., Culiacán, Mexico
| | - Rosalio Ramos-Payan
- Faculty of Biological and Chemical Sciences, Universidad Autónoma de Sinaloa, Culiacán, Mexico
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Amin NH, Hamed MIA, Abdel-Fattah MM, Abusabaa AHA, El-Saadi MT. Design, synthesis and mechanistic study of novel diarylpyrazole derivatives as anti-inflammatory agents with reduced cardiovascular side effects. Bioorg Chem 2021; 116:105394. [PMID: 34619468 DOI: 10.1016/j.bioorg.2021.105394] [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] [Received: 07/19/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Novel diarylpyrazole (5a-d, 6a-e, 12, 13, 14, 15a-c and 11a-g) derivatives were designed, synthesized and evaluated for their dual COX-2/sEH inhibitory activities via recombinant enzyme assays to explore their anti-inflammatory activities and cardiovascular safety profiles. Comprehensively, the structures of the synthesized compounds were established via spectral and elemental analyses, followed by the assessment of both their in vitro COX inhibitory and in vivo anti-inflammatory activities. The most active compounds as COX inhibitors were further evaluated for their in vitro 5-LOX and sEH inhibitory activities, alongside with their in vivo analgesic and ulcerogenic effects. Compounds 6d and 11f showed excellent inhibitory activities against both COX-2 and sEH (COX-2 IC50 = 0.043 and 0.048 µM; sEH IC50 = 83.58 and 83.52 μM, respectively). Moreover, the compounds demonstrated promising results as anti-inflammatory and analgesic agents with considerable ED50 values and gastric safety profiles. Remarkably, the most active COX inhibitors 6d and 11f possessed improved cardiovascular safety profiles, if compared to celecoxib, as shown by the laboratory evaluation of both essential cardiac biochemical parameters (troponin-1, prostacyclin, tumor necrosis factor-α, lactate dehydrogenase, reduced glutathione and creatine kinase-M) and histopathological studies. On the other hand, docking simulations confirmed that the newly synthesized compounds displayed sufficient structural features required for binding to the target COX-2 and sEH enzymes. Also, in silico ADME studies prediction and drug-like properties of the compounds revealed favorable oral bioavailability results. Collectively, the present work could be featured as a promising future approach towards novel selective COX-2 inhibitors with declined cardiovascular risks.
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Affiliation(s)
- Noha H Amin
- Department of Medicinal Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt.
| | - Mohammed I A Hamed
- Department of Organic and Medicinal Chemistry, Faculty of Pharmacy, Fayoum University, 63514, Egypt
| | - Maha M Abdel-Fattah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Ahmed H A Abusabaa
- Department of Organic and Medicinal Chemistry, Faculty of Pharmacy, Fayoum University, 63514, Egypt
| | - Mohammed T El-Saadi
- Department of Medicinal Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt; Department of Medicinal Chemistry, Faculty of Pharmacy, Sinai University-Kantra Branch, Egypt
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4
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Hempenius M, Groenwold RHH, de Boer A, Klungel OH, Gardarsdottir H. Drug exposure misclassification in pharmacoepidemiology: Sources and relative impact. Pharmacoepidemiol Drug Saf 2021; 30:1703-1715. [PMID: 34396634 PMCID: PMC9292927 DOI: 10.1002/pds.5346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drug exposure assessment based on dispensing data can be misclassified when patients do not adhere to their therapy or when information about over-the-counter drugs is not captured in the study database. Previous research has considered hypothetical sensitivity and specificity values, whereas this study aims to assess the impact of literature-based real values of exposure misclassification. METHODS A synthetic cohort study was constructed based on the proportion of exposure theoretically captured in a database (range 0.5-1.0) and the level of adherence (0.5-1.0). Three scenarios were explored: nondifferential misclassification, differential misclassification (misclassifications dependent on an unmeasured risk factor doubling the outcome risk), and nondifferential misclassification in a comparative effectiveness study (RRA and RRB both 2.0 compared to nonuse, RRA-B 1.0). RESULTS For the scenarios with nondifferential misclassification, 25% nonadherence or 25% uncaptured exposure changed the RR from 2.0 to 1.75, and 1.95, respectively. Applying different proportions of nonadherence or uncaptured use (20% vs. 40%) for subgroups with and without the risk factor, an RR of 0.95 was observed in the absence of a true effect (i.e., true RR = 1). In the comparative effectiveness study, no effect on RR was seen for different proportions of uncaptured exposure; however, different levels of nonadherence for the drugs (20% vs. 40%) led to an underestimation of RRA-B (0.89). DISCUSSION All scenarios led to biased estimates, but the magnitude of the bias differed across scenarios. When testing the robustness of findings of pharmacoepidemiologic studies, we recommend using realistic values of nonadherence and uncaptured exposure based on real-world data.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Department of Clinical Pharmacy, Division Laboratory and PharmacyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Faculty of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
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Khan J, Ali G, Rashid U, Khan R, Jan MS, Ullah R, Ahmad S, Abbasi SW, Khan Khalil AA, Sewell RE. Mechanistic evaluation of a novel cyclohexenone derivative's functionality against nociception and inflammation: An in-vitro, in-vivo and in-silico approach. Eur J Pharmacol 2021; 902:174091. [PMID: 33865830 DOI: 10.1016/j.ejphar.2021.174091] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
The synthesis of a novel cyclohexanone derivative (CHD; Ethyl 6-(4-metohxyphenyl)-2-oxo-4-phenylcyclohexe-3-enecarboxylate) was described and the subsequent aim was to perform an in vitro, in vivo and in silico pharmacological evaluation as a putative anti-nociceptive and anti-inflammatory agent in mice. Initial in vitro studies revealed that CHD inhibited both cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX) enzymes and it also reduced mRNA expression of COX-2 and the pro-inflammatory cytokines TNF-α and IL-1β. It was then shown that CHD dose dependently inhibited chemically induced tonic nociception in the abdominal constriction assay and also phasic thermal nociception (i.e. anti-nociception) in the hot plate and tail immersion tests in comparison with aspirin and tramadol respectively. The thermal test outcomes indicated a possible moderate centrally mediated anti-nociception which, in the case of the hot plate test, was pentylenetetrazole (PTZ) and naloxone reversible, implicating GABAergic and opioidergic mechanisms. CHD was also effective against both the neurogenic and inflammatory mediator phases induced in the formalin test and it also disclosed anti-inflammatory activity against the phlogistic agents, carrageenan, serotonin, histamine and xylene compared with standard drugs in edema volume tests. In silico studies indicated that CHD possessed preferential affinity for GABAA, opioid and COX-2 target sites and this was supported by molecular dynamic simulations where computation of free energy of binding also favored the formation of stable complexes with these sites. These findings suggest that CHD has prospective anti-nociceptive and anti-inflammatory properties, probably mediated through GABAergic and opioidergic interactions supplemented by COX-2 and 5-LOX enzyme inhibition in addition to reducing pro-inflammatory cytokine expression. CHD may therefore possess potentially beneficial therapeutic effectiveness in the management of inflammation and pain.
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Affiliation(s)
- Jawad Khan
- Department of Pharmacy, University of Peshawar, Peshawar, 25120, Pakistan
| | - Gowhar Ali
- Department of Pharmacy, University of Peshawar, Peshawar, 25120, Pakistan.
| | - Umer Rashid
- Department of Chemistry, COMSATS University Islamabad, Abbottabad Campus, Pakistan
| | - Rasool Khan
- Institute of Chemical Sciences, University of Peshawar, 25120, Pakistan
| | - Muhammad Saeed Jan
- Department of Pharmacy, Faculty of Biological Sciences, University of Malakand, Chakdara, 18000 Dir (L), Pakistan
| | - Rahim Ullah
- Department of Pharmacy, University of Peshawar, Peshawar, 25120, Pakistan
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, 25000, Pakistan
| | - Sumra Wajid Abbasi
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, 46000, Pakistan
| | - Atif Ali Khan Khalil
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, 46000, Pakistan
| | - RobertD E Sewell
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, CF10 3NB, UK. UK
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Abd-El-Aziz AS, Abdelghani AA, El-Ghezlani EG, Abou El-Ezz D, Abdel-Rahman LH. Pharmacological Evaluation of Novel Organoiron Dendrimers as Antimicrobial and Anti-Inflammatory Agents. Macromol Biosci 2020; 21:e2000242. [PMID: 33063474 DOI: 10.1002/mabi.202000242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/23/2020] [Indexed: 11/11/2022]
Abstract
The synthesis of a novel and attractive class of nonsteroidal anti-inflammatory and antimicrobial organoiron dendrimers attached to the well-known drug ibuprofen is achieved. The structures of these dendrimers are established by spectroscopic and analytical techniques. The antimicrobial activity of these dendrimers is investigated and tested against five human pathogenic Gram-positive and Gram-negative bacteria, and minimum inhibitory concentrations are reported. Some of these synthesized dendrimers exhibit higher inhibitory activity against methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and Staphylococcus warneri compare to the reference drugs. As well, the in vitro and in vivo anti-inflammatory activities of these dendrimers are evaluated. The results of in vivo anti-inflammatory activity and histopathology of inflamed paws show that all dendrimers display considerable anti-inflammatory activity; however, second-generation dendrimer (G2-D6) shows the best anti-inflammatory activity, which is more potent than the commercial drug ibuprofen at the same tested dose. Results of the toxicity study reveal that G2-D6 is the safest drug on biological tissues.
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Affiliation(s)
- Alaa S Abd-El-Aziz
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Amani A Abdelghani
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Ebtehal G El-Ghezlani
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Doaa Abou El-Ezz
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA University), Giza, 12566, Egypt
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Zong L, Zhang J, Dai L, Liu J, Yang Y, Xie J, Luo X. The Anti-Inflammatory Properties of Rhododendron molle Leaf Extract in LPS-Induced RAW264.7. Chem Biodivers 2020; 17:e2000477. [PMID: 32845053 DOI: 10.1002/cbdv.202000477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/24/2020] [Indexed: 01/20/2023]
Abstract
Rhododendron molle G.Don is a well-known traditional medicine which has been used to treat rheumatic inflammation. In this study, an inflammatory model of lipopolysaccharide (LPS)-stimulated RAW264.7 cells was established to analyze the anti-inflammatory effect and potential mechanism of the methanol extract of R. molle leaves (RLE). The production of NO and the expression of tumor necrosis factor by LPS were detected by Griess reaction and enzyme linked immunosorbent assay (ELISA). The mRNA expression of TNF-α, IL-1β, IL-6, COX-2 and iNOS was measured by qRT-PCR assay. Griess and qRT-PCR showed that the RLE could significantly concentration-dependently inhibit NO production and the expression of many pro-inflammatory cytokines and inflammatory-related enzymes. Scanning electron microscope (SEM) analysis indicated that RLE could inhibit LPS-stimulated RAW264.7 macrophages activation. The protein level of TNF-α and IL-1β were decreased over 50 % at 100 μg/ml of RLE, as detected by ELISA. These results indicated that RLE had strong anti-inflammatory and immunomodulatory activity.
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Affiliation(s)
- Luye Zong
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Jin Zhang
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Liangfang Dai
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Jian Liu
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Yan Yang
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Jiankun Xie
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
| | - Xiangdong Luo
- College of Life Science, Jiangxi Normal University, Nanchang, 330022, P. R. China
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Tremblay S, Boutin J, Perreault M, Côté MF, Gobeil S, C.-Gaudreault R. Synthesis and evaluation of substituted phenyl cycloalkylureas and bioisosteres as IL-6 expression inhibitors. Med Chem Res 2020. [DOI: 10.1007/s00044-020-02557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Koshak AE, Abdallah HM, Esmat A, Rateb ME. Anti-inflammatory Activity and Chemical Characterisation of Opuntia ficus-indica Seed Oil Cultivated in Saudi Arabia. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2020. [DOI: 10.1007/s13369-020-04555-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Szeto CC, Sugano K, Wang JG, Fujimoto K, Whittle S, Modi GK, Chen CH, Park JB, Tam LS, Vareesangthip K, Tsoi KKF, Chan FKL. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations. Gut 2020; 69:617-629. [PMID: 31937550 DOI: 10.1136/gutjnl-2019-319300] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/06/2019] [Accepted: 12/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications. OBJECTIVE To develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs. METHODS Randomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations. RESULTS Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases. CONCLUSION NSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong.,Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong
| | - Kentaro Sugano
- Jichi Medical University, Shimotsuke, Tochigi, Japan.,Asian Pacific Association of Gastroenterology (APAGE), Tochigi, Japan
| | - Ji-Guang Wang
- Shanghai Institute of Hypertension, Shanghai, Shanghai, China.,Asia Pacific Society of Hypertension (APSH), Shanghai, China
| | - Kazuma Fujimoto
- Saga University, Saga, Japan.,Asia-Pacific Society for Digestive Endoscopy (APSDE), Saga, Japan
| | - Samuel Whittle
- The University of Adelaide, Adelaide, South Australia, Australia.,Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia
| | - Gopesh K Modi
- Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong.,Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Chen-Huen Chen
- National Yang-Ming University, Taipei, Taiwan.,Pulse of Asia (PoA), Taipei, Taiwan
| | - Jeong-Bae Park
- Pulse of Asia (PoA), Taipei, Taiwan.,JB Lab and Clinic and Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong.,Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia
| | - Kriengsak Vareesangthip
- Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong.,Mahidol University, Nakorn Pathom, Thailand
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Dasari SR, Tondepu S, Vadali LR, Seelam N. Retracted
: Design, Synthesis and Molecular Modeling of Nonsteroidal Anti‐inflammatory Drugs Tagged Substituted 1,2,3‐Triazole Derivatives and Evaluation of Their Biological Activities. J Heterocycl Chem 2019. [DOI: 10.1002/jhet.3503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Srinivasa Rao Dasari
- Department of Chemistry Koneru Lakshmaiah Education Foundation, Vaddeswaram Guntur Andhra Pradesh 522502 India
- API‐Chemical Research Division Mylan Laboratories Ltd Hyderabad Telangana 500049 India
| | - Subbaiah Tondepu
- Department of Chemical Engineering Vignan's Foundation for Science, Technology and Research, Vadlamudi Guntur Andhra Pradesh 522213 India
| | - Lakshmana Rao Vadali
- API‐Chemical Research Division Mylan Laboratories Ltd Hyderabad Telangana 500049 India
| | - Nareshvarma Seelam
- Department of Chemistry Koneru Lakshmaiah Education Foundation, Vaddeswaram Guntur Andhra Pradesh 522502 India
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12
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Szczęśniak-Sięga BM, Mogilski S, Wiglusz RJ, Janczak J, Maniewska J, Malinka W, Filipek B. Synthesis and pharmacological evaluation of novel arylpiperazine oxicams derivatives as potent analgesics without ulcerogenicity. Bioorg Med Chem 2019; 27:1619-1628. [PMID: 30852078 DOI: 10.1016/j.bmc.2019.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 11/25/2022]
Abstract
Gastrotoxicity continues to be a major issue in therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Medicine is yet to develop absolutely safe analgesics. Numerous strategies are employed to discover new, safer NSAIDs, for example selective inhibition of cyclooxygenase-2, new molecular targets (e.g. microsomal prostaglandin E2 synthase-1), incorporation of cytoprotective compounds in the drug molecule or modification of the classic NSAIDs currently available on the market. The research presented in this paper is indicative of a current worldwide trend in this area of science, and is an example of the fourth strategy noted above. Two series of new arylpiperazine derivatives of the classic NSAID - piroxicam, were developed by conventional synthesis. The full range of compounds obtained proved to be between two and five times analgesically more potent than the reference drug and, most importantly, they did not show any ulcerogenic activity.
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Affiliation(s)
- Berenika M Szczęśniak-Sięga
- Department of Chemistry of Drugs, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland.
| | - Szczepan Mogilski
- Department of Pharmacodynamics, Faculty of Pharmacy, Medical College, Jagiellonian University, Medyczna 9, 30-688 Krakow, Poland
| | - Rafał J Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, P.O. Box 1410, 50-950 Wroclaw, Poland; Centre for Advanced Materials and Smart Structures, Polish Academy of Sciences, Okólna 2, 50-950 Wroclaw, Poland
| | - Jan Janczak
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, P.O. Box 1410, 50-950 Wroclaw, Poland
| | - Jadwiga Maniewska
- Department of Chemistry of Drugs, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Wiesław Malinka
- Department of Chemistry of Drugs, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Barbara Filipek
- Department of Pharmacodynamics, Faculty of Pharmacy, Medical College, Jagiellonian University, Medyczna 9, 30-688 Krakow, Poland
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13
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Eshaghian R, Mazaheri M, Ghanadian M, Rouholamin S, Feizi A, Babaeian M. The effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) on heavy menstrual bleeding: A randomized, placebo-controlled, clinical trial. Complement Ther Med 2019; 42:42-47. [PMID: 30670277 DOI: 10.1016/j.ctim.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate the effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) as complementary treatments for heavy menstrual bleeding (HMB) among women of reproductive age. DESIGN Randomized, placebo-controlled, clinical trial. SETTING Gynecology outpatient clinics. INTERVENTIONS Patients with HMB (n = 102) were randomly assigned to three groups. All patients received ibuprofen (200 mg) and either frankincense (300 mg), ginger (300 mg), or a placebo, which contains 200 mg anhydrous lactose as the filling agent and was similar in appearance to the two other drugs. Patients received the medications three times a day for seven days of the menstrual cycle, starting from the first bleeding day and this was repeated for two consecutive menstrual cycles. MAIN OUTCOME MEASURES Amount and duration of menstrual bleeding and quality of life (QOL). RESULTS Duration of menstrual bleeding was decreased in the frankincense (-1.77 ± 2.47 days, P = 0.003) and ginger (-1.8 ± 1.79 days, P = 0.001) groups, but not in the placebo group (-0.52 ± 1.86 days, P = 0.42). Amount of menstrual bleeding was decreased in all (P < 0.05), with no difference among the study groups (P > 0.05). More improvement in QOL was observed in the frankincense (-25.7 ± 3.1; P < 0.001) and ginger (-29.2 ± 3.7: P < 0.001) groups compared to the placebo group (-15.07 ± 3.52; P < 0.001) and between the groups, differences were statistically significant (P = 0.02). CONCLUSIONS Ginger and frankincense seem to be effective complementary treatments for HMB. Further studies with a larger sample size and longer follow-up are warranted in this regard.
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Affiliation(s)
- Razieh Eshaghian
- Department of Persian Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Mazaheri
- Department of Persian Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mustafa Ghanadian
- Department of Pharmacognosy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, and Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahmoud Babaeian
- Department of Persian Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abdelgawad MA, Bakr RB, Azouz AA. Novel pyrimidine-pyridine hybrids: Synthesis, cyclooxygenase inhibition, anti-inflammatory activity and ulcerogenic liability. Bioorg Chem 2018; 77:339-348. [DOI: 10.1016/j.bioorg.2018.01.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/03/2023]
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15
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Manrique-Moreno M, Heinbockel L, Suwalsky M, Garidel P, Brandenburg K. Biophysical study of the non-steroidal anti-inflammatory drugs (NSAID) ibuprofen, naproxen and diclofenac with phosphatidylserine bilayer membranes. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2016; 1858:2123-2131. [DOI: 10.1016/j.bbamem.2016.06.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/19/2016] [Accepted: 06/10/2016] [Indexed: 11/27/2022]
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16
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Allemand A, Leonardi BF, Zimmer AR, Moreno S, Romão PRT, Gosmann G. Red Pepper (Capsicum baccatum) Extracts Present Anti-Inflammatory Effects In Vivo and Inhibit the Production of TNF-α and NO In Vitro. J Med Food 2016; 19:759-67. [DOI: 10.1089/jmf.2015.0101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alexandra Allemand
- Laboratory of Phytochemistry and Organic Synthesis, Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Cell and Molecular Immunology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Bianca Franco Leonardi
- Laboratory of Phytochemistry and Organic Synthesis, Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Rigon Zimmer
- Laboratory of Phytochemistry and Organic Synthesis, Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Susana Moreno
- Graduate Program in Biotechnology, Catholic University Dom Bosco, Campo Grande, MS, Brazil
| | - Pedro Roosevelt Torres Romão
- Laboratory of Cell and Molecular Immunology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Grace Gosmann
- Laboratory of Phytochemistry and Organic Synthesis, Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Leyva-López N, Gutierrez-Grijalva EP, Ambriz-Perez DL, Heredia JB. Flavonoids as Cytokine Modulators: A Possible Therapy for Inflammation-Related Diseases. Int J Mol Sci 2016; 17:E921. [PMID: 27294919 PMCID: PMC4926454 DOI: 10.3390/ijms17060921] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 12/20/2022] Open
Abstract
High levels of cytokines, such as interleukin (IL)-1β, tumor necrosis factor (TNF)-α and IL-6, are associated with chronic diseases like rheumatoid arthritis, asthma, atherosclerosis, Alzheimer's disease and cancer; therefore cytokine inhibition might be an important target for the treatment of these diseases. Most drugs used to alleviate some inflammation-related symptoms act by inhibiting cyclooxygenases activity or by blocking cytokine receptors. Nevertheless, these drugs have secondary effects when used on a long-term basis. It has been mentioned that flavonoids, namely quercetin, apigenin and luteolin, reduce cytokine expression and secretion. In this regard, flavonoids may have therapeutical potential in the treatment of inflammation-related diseases as cytokine modulators. This review is focused on current research about the effect of flavonoids on cytokine modulation and the description of the way these compounds exert their effect.
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Affiliation(s)
- Nayely Leyva-López
- Centro de Investigación en Alimentación y Desarrollo A.C., Carretera a Eldorado Km 5.5 Col. El Diez, 80110 Culiacán, Sinaloa, Mexico.
| | - Erick P Gutierrez-Grijalva
- Centro de Investigación en Alimentación y Desarrollo A.C., Carretera a Eldorado Km 5.5 Col. El Diez, 80110 Culiacán, Sinaloa, Mexico.
| | - Dulce L Ambriz-Perez
- Universidad Politécnica del Mar y la Sierra, Carretera a Potrerillos del Norote/La Cruz Km 3, La Cruz, 82740 Elota, Sinaloa, Mexico.
| | - J Basilio Heredia
- Centro de Investigación en Alimentación y Desarrollo A.C., Carretera a Eldorado Km 5.5 Col. El Diez, 80110 Culiacán, Sinaloa, Mexico.
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Dias SFL, Nogueira SS, de França Dourado F, Guimarães MA, de Oliveira Pitombeira NA, Gobbo GG, Primo FL, de Paula RCM, Feitosa JPA, Tedesco AC, Nunes LCC, Leite JRSA, da Silva DA. Acetylated cashew gum-based nanoparticles for transdermal delivery of diclofenac diethyl amine. Carbohydr Polym 2016; 143:254-61. [DOI: 10.1016/j.carbpol.2016.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
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Abstract
Gastroenterologists care for users of nonsteroidal anti-inflammatory drugs (NSAIDs) when the vast population exposed to the medication class experiences a relatively uncommon serious gastrointestinal (GI) side effect. As serious adverse cardiovascular (CV) effects of these drugs have also been recognized, there remains continued confusion about the best treatment for patients who benefit from NSAID therapy and are at risk for GI and CV adverse events. Recognition of those patients at risk and strategies to reduce the adverse side effects of NSAIDs continues to provide an opportunity to improve patient outcomes. This review discusses the injury induced by these agents throughout the GI tract as well as strategies to prevent acute injury and reduce the development of serious adverse events. NSAID medication selection as well as GI cotherapy should balance individual patients' GI and CV risks.
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Kim HU. Diagnostic and Treatment Approaches for Refractory Peptic Ulcers. Clin Endosc 2015; 48:285-90. [PMID: 26240800 PMCID: PMC4522418 DOI: 10.5946/ce.2015.48.4.285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 12/15/2022] Open
Abstract
Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.
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Affiliation(s)
- Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Cortes-Ciriano I, Murrell DS, van Westen GJ, Bender A, Malliavin TE. Prediction of the potency of mammalian cyclooxygenase inhibitors with ensemble proteochemometric modeling. J Cheminform 2015; 7:1. [PMID: 25705261 PMCID: PMC4335128 DOI: 10.1186/s13321-014-0049-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/21/2014] [Indexed: 12/16/2022] Open
Abstract
Cyclooxygenases (COX) are present in the body in two isoforms, namely: COX-1, constitutively expressed, and COX-2, induced in physiopathological conditions such as cancer or chronic inflammation. The inhibition of COX with non-steroideal anti-inflammatory drugs (NSAIDs) is the most widely used treatment for chronic inflammation despite the adverse effects associated to prolonged NSAIDs intake. Although selective COX-2 inhibition has been shown not to palliate all adverse effects (e.g. cardiotoxicity), there are still niche populations which can benefit from selective COX-2 inhibition. Thus, capitalizing on bioactivity data from both isoforms simultaneously would contribute to develop COX inhibitors with better safety profiles. We applied ensemble proteochemometric modeling (PCM) for the prediction of the potency of 3,228 distinct COX inhibitors on 11 mammalian cyclooxygenases. Ensemble PCM models ([Formula: see text], and RMSEtest = 0.71) outperformed models exclusively trained on compound ([Formula: see text], and RMSEtest = 1.09) or protein descriptors ([Formula: see text] and RMSEtest = 1.10) on the test set. Moreover, PCM predicted COX potency for 1,086 selective and non-selective COX inhibitors with [Formula: see text] and RMSEtest = 0.76. These values are in agreement with the maximum and minimum achievable [Formula: see text] and RMSEtest values of approximately 0.68 for both metrics. Confidence intervals for individual predictions were calculated from the standard deviation of the predictions from the individual models composing the ensembles. Finally, two substructure analysis pipelines singled out chemical substructures implicated in both potency and selectivity in agreement with the literature. Graphical AbstractPrediction of uncorrelated bioactivity profiles for mammalian COX inhibitors with Ensemble Proteochemometric Modeling.
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Affiliation(s)
- Isidro Cortes-Ciriano
- Département de Biologie Structurale et Chimie, Institut Pasteur, Unité de Bioinformatique Structurale; CNRS UMR 3825, 25, rue du Dr Roux, Paris, 75015 France
| | - Daniel S Murrell
- Centre for Molecular Science Informatics, Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Gerard Jp van Westen
- European Molecular Biology Laboratory European Bioinformatics Institute Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SD UK
| | - Andreas Bender
- Centre for Molecular Science Informatics, Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Thérèse E Malliavin
- Département de Biologie Structurale et Chimie, Institut Pasteur, Unité de Bioinformatique Structurale; CNRS UMR 3825, 25, rue du Dr Roux, Paris, 75015 France
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Narsinghani T, Sharma R. Lead Optimization on Conventional Non-Steroidal Anti-Inflammatory Drugs: An Approach to Reduce Gastrointestinal Toxicity. Chem Biol Drug Des 2014; 84:1-23. [DOI: 10.1111/cbdd.12292] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 10/18/2013] [Accepted: 11/12/2013] [Indexed: 01/17/2023]
Affiliation(s)
- Tamanna Narsinghani
- School of Pharmacy; Devi Ahilya Vishwavidyalaya; Takshashila Campus, Ring Road Indore 452 001 MP India
| | - Rajesh Sharma
- School of Pharmacy; Devi Ahilya Vishwavidyalaya; Takshashila Campus, Ring Road Indore 452 001 MP India
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Arden NK, Åkermark C, Andersson M, Todman MG, Altman RD. A randomized saline-controlled trial of NASHA hyaluronic acid for knee osteoarthritis. Curr Med Res Opin 2014; 30:279-86. [PMID: 24168077 DOI: 10.1185/03007995.2013.855631] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE NASHA hyaluronic acid is administered as a single intra-articular injection to treat the symptoms of osteoarthritis (OA). In a previous trial, post-hoc analysis indicated that NASHA provides significantly greater pain relief than saline in patients with OA confined to the study knee. We aimed to evaluate the safety and efficacy of NASHA in patients with unilateral knee OA. RESEARCH DESIGN AND METHODS This was a randomized, double-blind, saline-controlled trial. All patients had knee OA confirmed by American College of Rheumatology criteria and a WOMAC pain score of 7-17 in the study knee, but no pain in the previous 3 months in the non-study knee. Treatment comprised a single intra-articular injection of NASHA or saline control. The follow-up period was 6 weeks. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01806207. MAIN OUTCOME MEASURES The primary efficacy endpoint was the responder rate, defined as the percentage of patients with ≥40% improvement from baseline in WOMAC pain score and an absolute improvement of ≥5 points. RESULTS A total of 218 patients received study treatment (NASHA: 108, saline: 110). In the main intention-to-treat (ITT) analysis, no statistically significant difference in responder rate was found between the two groups at 6 weeks (NASHA: 30.6%; saline: 26.4%). A post-hoc subgroup analysis of patients without clinical effusion in the study knee at baseline showed a significantly higher 6 week responder rate with NASHA than with saline: 40.6% versus 19.7% (p = 0.0084). A total of 68 adverse events were reported among 44 patients in the NASHA group, compared with 69 adverse events among 44 patients in the saline group. The main weakness of the study was the short, 6 week follow-up duration. In addition, image guidance was not used to ensure injection as intended into the intra-articular space. CONCLUSIONS Single-injection NASHA was well tolerated and, although there was no significant benefit versus saline control in the primary analysis, post-hoc analysis showed a statistically significant improvement in pain relief at 6 weeks among patients without clinical effusion at baseline.
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Affiliation(s)
- Nigel K Arden
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford , UK
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Singh Bahia M, Kumar Katare Y, Silakari O, Vyas B, Silakari P. Inhibitors of Microsomal Prostaglandin E2
Synthase-1 Enzyme as Emerging Anti-Inflammatory Candidates. Med Res Rev 2014; 34:825-55. [DOI: 10.1002/med.21306] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Malkeet Singh Bahia
- Molecular Modelling Lab (MML); Department of Pharmaceutical Sciences and Drug Research; Punjabi University; Patiala Punjab 147002 India
| | - Yogesh Kumar Katare
- Radharaman Institute of Pharmaceutical Sciences; Bhopal Madhya Pradesh 462046 India
| | - Om Silakari
- Molecular Modelling Lab (MML); Department of Pharmaceutical Sciences and Drug Research; Punjabi University; Patiala Punjab 147002 India
| | - Bhawna Vyas
- Department of Chemistry; Punjabi University; Patiala Punjab 147002 India
| | - Pragati Silakari
- Adina institute of Pharmaceutical Sciences; Sagar Madhya Pradesh (M.P.) 470001 India
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Impact of genetic polymorphisms on adenoma recurrence and toxicity in a COX2 inhibitor (celecoxib) trial: results from a pilot study. Pharmacogenet Genomics 2014; 23:428-437. [PMID: 23778325 DOI: 10.1097/fpc.0b013e3283631784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Chemoprevention trials have shown that celecoxib reduces adenoma recurrence but can cause cardiovascular toxicity. In this pilot study, we evaluated associations between genetic variation in several candidate pathways (e.g. prostaglandin synthesis) and adenoma recurrence and cardiovascular and gastrointestinal toxicities. METHODS Genotyping analysis was carried out on 117 Israeli colorectal adenoma patients who participated in the Prevention of Colorectal Sporadic Adenomatous Polyps trial. Reassessment followed after 3 years on celecoxib and after 2 years from termination of treatment with celecoxib. Efficacy (absence of colorectal adenomas) was measured by colonoscopy at years 1, 3, and 5. Toxicities were assessed by investigators during celecoxib treatment and by self-report post-treatment. A linkage disequilibrium-based selection algorithm (r2≥0.90, MAF≥4%) identified 255 tagSNPs in 25 analyzed candidate genes. Genotyping was performed by using Illumina GoldenGate technology. RESULTS Multiple genetic variants were associated with adenoma recurrence and toxicity. Genetic variability in COX1, COX2, and ALOX12/15 genes played a role in adenoma recurrence, particularly among patients on placebo. More gene variants (especially variants in PGES, CRP, SRC, and GPX3) were associated with increased risk for cardiovascular toxicity and symptoms, compared with gastrointestinal toxicity and symptoms. The increased risk for cardiovascular toxicity/symptoms associated with the SRC gene variants (rs6017996, rs6018256, rs6018257) ranged from 6.61 (95% confidence interval 1.66-26.36, P<0.01) to 10.71 (95% confidence interval 1.96-58.60, P<0.01). CONCLUSION Genetic polymorphisms in multiple inflammation-related genes appear to interact with celecoxib on adenoma recurrence and its attendant toxicity, particularly cardiovascular toxicity/symptoms. Larger studies validating these pharmacogenetic relationships are needed.
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Leighton R, Akermark C, Therrien R, Richardson JB, Andersson M, Todman MG, Arden NK. NASHA hyaluronic acid vs. methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis Cartilage 2014; 22:17-25. [PMID: 24185114 DOI: 10.1016/j.joca.2013.10.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 10/11/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare NASHA hyaluronic acid gel as single-injection intra-articular (IA) treatment for knee osteoarthritis (OA) against methylprednisolone acetate (MPA). DESIGN This was a prospective, multi-centre, randomized, active-controlled, double-blind, non-inferiority clinical trial. A unique, open-label extension phase (OLE) was undertaken to answer further important clinical questions. Subjects with painful unilateral knee OA were treated and followed for 26 weeks (blinded phase). All patients attending the clinic at 26 weeks were offered NASHA treatment, with a subsequent 26-week follow-up period (extension phase). The primary objective was to show non-inferiority of NASHA vs MPA in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain responder rate (percentage of patients with ≥40% improvement from baseline in WOMAC pain score and an absolute improvement of ≥5 points) at 12 weeks. RESULTS In total, 442 participants were enrolled. The primary objective was met, with NASHA producing a non-inferior response rate vs MPA at 12 weeks (NASHA: 44.6%; MPA: 46.2%; difference [95% CI]: 1.6% [-11.2%; +7.9%]). Effect size for WOMAC pain, physical function and stiffness scores favoured NASHA over MPA from 12 to 26 weeks. In response to NASHA treatment at 26 weeks, sustained improvements were seen in WOMAC outcomes irrespective of initial treatment. No serious device-related adverse events (AEs) were reported. CONCLUSIONS This study shows that single-injection NASHA was well tolerated and non-inferior to MPA at 12 weeks. The benefit of NASHA was maintained to 26 weeks while that of MPA declined. An injection of NASHA at 26 weeks conferred long-term improvements without increased sensitivity or risk of complications. STUDY IDENTIFIER: NCT01209364 (www.clinicaltrials.gov).
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Affiliation(s)
- R Leighton
- QEII Health Sciences Centre, New Halifax Infirmary, Halifax, NS, Canada.
| | - C Akermark
- Sport Med, Birger Jarlsgatan 106A, SE-11420 Stockholm, Sweden
| | - R Therrien
- Centre de Rhumatologie St-Louis, Saint-Foy, Quebec, Canada G1W4R4
| | - J B Richardson
- Robert Jones and Agnes Hunt Orthopaedic & District Hospital, Institute of Orthopaedics Oswestry, SY10 7AG, UK
| | - M Andersson
- Q-Med AB, Seminariegatan 21, 752 28 Uppsala, Sweden
| | - M G Todman
- Smith & Nephew UK Ltd, Research Centre, York Science Park, York, UK
| | - N K Arden
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK
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Miao FY, Li YF, Bu XH, Zhang FC. Clinical effects of amoxicillin combined with rabeprazole sodium enteric-coated capsules for NSAIDs associated peptic ulcer. Shijie Huaren Xiaohua Zazhi 2013; 21:4200-4203. [DOI: 10.11569/wcjd.v21.i36.4200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effects of amoxicillin combined with rabeprazole sodium enteric-coated capsules for NSAIDs associated peptic ulcer.
METHODS: One hundred and eighty-four patients with NSAIDs associated peptic ulcer (NSAIDs use ≥ 4 wk) were divided into an observation group (amoxicillin combined with rabeprazole sodium enteric-coated capsules) and a control group (placebo combined with rabeprazole sodium enteric-coated capsules), with 92 patients in each group. Each cycle consisted of 4 weeks of continuous administration. Therapeutic results and clinical symptoms were recorded, and bleeding events and adverse reactions were also recorded in the follow-up period.
RESULTS: The total effective rate was significantly higher in the observation group than in the control group (97.8% vs 90.2%, χ2 = 4.604, P < 0.05). The time to remission of gastric pain also differed between the two groups (2.9 d ± 1.1 d vs 4.3 d ± 1.6 d, t = 6.916, P < 0.05). The rates of gastrointestinal bleeding events at 6 mo and 1 year in the observation group were significantly lower than those in the control group (5.4% vs 14.1%, 8.7% vs 22.8%, χ2 = 4.301, 7.491, both P < 0.05). No adverse reactions were found in both groups.
CONCLUSION: Amoxicillin combined with rabeprazole sodium enteric-coated capsules is effective and safe in the treatment of NSAIDs associated peptic ulcer.
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Peloso PM, Khan M, Gross AR, Carlesso L, Santaguida L, Lowcock J, MacDermid JC, Walton D, Goldsmith CH, Langevin P, Shi Q. Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON Project. Open Orthop J 2013; 7:473-93. [PMID: 24155805 PMCID: PMC3802125 DOI: 10.2174/1874325001307010473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. SEARCH STRATEGY Computerized databases and grey literature were searched from 2006 to 2012. SELECTION CRITERIA Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. DATA COLLECTION & ANALYSIS Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. MAIN RESULTS We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; REVIEWERS' CONCLUSIONS While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain.
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Peng T, Zhu AL, Zhou YN, Hu T, Yue ZF, Chen DD, Wang GM, Kang J, Fan CL, Chen Y, Jiang HY. Development of a simple method for simultaneous determination of nine subclasses of non-steroidal anti-inflammatory drugs in milk and dairy products by ultra-performance liquid chromatography with tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 933:15-23. [DOI: 10.1016/j.jchromb.2013.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/07/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
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The use of proton pump inhibitors in treating and preventing NSAID-induced mucosal damage. Arthritis Res Ther 2013; 15 Suppl 3:S5. [PMID: 24267413 PMCID: PMC3891010 DOI: 10.1186/ar4177] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
NSAIDs are prescribed widely but have rare serious gastrointestinal side effects. More recently, adverse cardiovascular effects of these drugs have also been recognized, leading to the withdrawal of some agents and continuing uncertainty about the best approach for patients requiring NSAID therapy. Proton pump inhibitors (PPIs) provide potent and long-lasting inhibition of gastric acid secretion and have proven efficacy in healing NSAID-associated ulcers, including those with continued exposure to NSAIDs. PPIs have also shown efficacy in reducing the risk of ulcerations due to NSAID use compared with NSAIDs alone in randomized controlled trials (RCTs) where endoscopic ulcers are used as the primary endpoint, albeit a surrogate marker for clinical ulcers and complications. Large RCT outcome trials comparing patients exposed to NSAIDs with and without PPI co-therapy have not been performed, but adequately powered RCTs in high-risk patients demonstrate that PPI + nonselective NSAID provides similar rates of symptomatic ulcer recurrence rates as the use of a cyclooxygenase (COX)-2 selective inhibitor. A RCT in high-risk patients with previous ulcer complications supports the additive bene3 t of two risk-reducing strategies, as ulcer complication recurrence was eliminated in high-risk patients who were given a COX-2 selective agent with a PPI. Helicobacter pylori, an independent risk factor for ulcers, should be sought out and eradicated in patients at increased gastrointestinal risk, typically those with an ulcer history. Following H. pylori eradication, however, patients remain at risk and co-therapy with a PPI is recommended. NSAID medication selection should consider both the individual patients' gastrointestinal and cardiovascular risks.
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Le Ray I, Barkun AN, Vauzelle-Kervroëdan F, Bardou M. Failure to renew prescriptions for gastroprotective agents to patients on continuous nonsteroidal anti-inflammatory drugs increases rate of upper gastrointestinal injury. Clin Gastroenterol Hepatol 2013; 11:499-504.e1. [PMID: 23313838 DOI: 10.1016/j.cgh.2012.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/20/2012] [Accepted: 12/07/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with risk factors for gastrointestinal (GI) disorders who continuously use nonsteroidal anti-inflammatory drugs (NSAIDs) also should take gastroprotective agents (GPAs), such as proton pump inhibitors (PPIs). However, it is not clear how many physicians continue to prescribe GPAs to these patients, and whether stopping the GPA prescription increases GI complications. METHODS We performed a retrospective, observational, longitudinal study using a validated electronic database of representative general practitioners in France. We analyzed data for 1856 patients at risk for GI events (>65 y, past history of GI ulcer, or receiving antiplatelet agents) who received prescriptions for an NSAID and PPI from 2007 to 2009. Kaplan-Meier curves were used to determine the probability of still being prescribed a GPA at 12 and 24 months after the first prescription. Multivariate logistic regression analysis was used to identify factors associated with nonpersistence. GI complication rates were compared using the Student t test. RESULTS The probability of still being prescribed a PPI along with an NSAID 1 year after the study began was 77.5% (95% confidence interval [CI], 75.6%-79.4%) and 68.3% after 2 years (95% CI, 66.1%-70.4%). Risk factors for no longer receiving a prescription for a PPI included switching to a cyclooxygenase-2-selective inhibitor (hazard ratio [HR], 2.50; 95% CI, 1.91-3.28; P < .001) or to a nonselective NSAID (HR, 1.63; 95% CI, 1.33-1.99; P < .001), and female sex (HR, 1.25; 95% CI, 1.05-1.45; P < .05). In 50% of these cases, the PPI was reintroduced within 6 months, without a specific reason in 70% of the cases. The risk for upper GI injury was higher among patients with discontinued prescriptions for PPIs (odds ratio, 1.45; 95% CI, 1.06-2.09; P = .02). CONCLUSIONS Within 2 years after prescribing a PPI, physicians do not renew this prescription for approximately 33% of patients receiving continuous NSAIDs. This increases the risk for GI adverse events among these patients.
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Affiliation(s)
- Isabelle Le Ray
- INSERM Centre d'Investigations Cliniques Plurithématique 803, Centre Hospitalier Universitaire du Bocage, Dijon, France
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Narayanan D, M G G, H L, Koyakutty M, Nair S, Menon D. Poly-(ethylene glycol) modified gelatin nanoparticles for sustained delivery of the anti-inflammatory drug Ibuprofen-Sodium: an in vitro and in vivo analysis. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2013; 9:818-28. [PMID: 23428986 DOI: 10.1016/j.nano.2013.02.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 12/07/2012] [Accepted: 02/02/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED The limited bioavailability and rapid clearance of the anti-inflammatory drug Ibuprofen Sodium (IbS) necessitates repeated drug administration. To address this, injectable IbS loaded PEGylated gelatin nanoparticles (PIG NPs) of size ~200nm and entrapment efficiency ~70%, providing sustained release in vitro were prepared by a modified two-step desolvation process. The developed nanomedicine, containing a range of IbS concentrations up to 1mg/mL proved to be non-toxic, hemocompatible and non-immunogenic, when tested through various in vitro assays and was reaffirmed by in vivo cytokine analysis. HPLC analysis of intravenously administered PIG NPs showed a sustained release of IbS for ~4days with improved bioavailability and pharmacokinetics when compared to bare IbS and IbS-loaded non-PEGylated GNPs. Histological analysis of liver and kidney revealed tissue integrity as in the control, indicating biocompatibility of PIG NPs. The results demonstrate improved plasma half-life of IbS when encapsulated within nanogelatin, thereby aiding reduction in its frequency of administration. FROM THE CLINICAL EDITOR In this preclinical study, improved plasma half-life of ibuprofen sodium was demonstrated when encapsulated within PEGylated gelatin nanoparticles of ~200 nm size, expected to lead to reduced frequency of administration in future clinical applications.
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Affiliation(s)
- Dhanya Narayanan
- Amrita Centre for Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Ullah N, Ul Islam N, Ali G, Subhan F, Faridoon, Khan I. Bioisosteric synthesis of nitrogen containing derivatives of salicyl alcohol, their in vivo pharmacological studies with molecular modeling. Med Chem Res 2013. [DOI: 10.1007/s00044-013-0473-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Periprocedural analgesic therapy is an often overlooked, but critical component of ensuring adequate surgical patient care and overall satisfaction with surgical outcomes. Adequate pain management requires thorough assessment of pain and complete knowledge and understanding of the various therapeutic agents available. OBJECTIVES To further the knowledge and understanding of current strategies in pain management. METHODS A literature review was conducted through PubMed to define current pain assessment and management strategies. RESULTS AND CONCLUSIONS Appropriate pain assessment leads to the selection of optimal pharmacologic options for pain control in the acute postoperative setting.
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Affiliation(s)
- Lana N Kashlan
- Department of Dermatology, Boston University, Boston, Massachusetts 02118, USA.
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Riaño S, Alcudia-León MC, Lucena R, Cárdenas S, Valcárcel M. Determination of non-steroidal anti-inflammatory drugs in urine by the combination of stir membrane liquid–liquid–liquid microextraction and liquid chromatography. Anal Bioanal Chem 2012; 403:2583-9. [DOI: 10.1007/s00216-012-6051-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 04/10/2012] [Accepted: 04/15/2012] [Indexed: 11/24/2022]
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Marks JL, Colebatch AN, Buchbinder R, Edwards CJ. Pain management for rheumatoid arthritis and cardiovascular or renal comorbidity. Cochrane Database Syst Rev 2011:CD008952. [PMID: 21975789 DOI: 10.1002/14651858.cd008952.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pain in rheumatoid arthritis is common, is often multi-factorial and many different pharmacotherapeutic agents are routinely used for pain management. There are concerns that some of the pain pharmacotherapies currently used may increase the risk of adverse events in people with rheumatoid arthritis and concurrent cardiovascular or renal disease. OBJECTIVES To systematically assess and collate the scientific evidence on the efficacy and safety of using pain pharmacotherapy in people with rheumatoid arthritis and cardiovascular or renal comorbidities. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 4); MEDLINE, from 1950; EMBASE, from 1980; the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE). We also handsearched the conference proceedings for American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) for 2008-09, and checked the websites of regulatory agencies for reported adverse events, labels and warnings. SELECTION CRITERIA We considered randomised controlled trials and non-randomised studies comparing the efficacy and safety of pain pharmacotherapies in patients with rheumatoid arthritis, with and without comorbid cardiovascular or renal conditions.In addition, we also considered controlled before-after studies, interrupted time series, cohort and case control studies and case series (N ≥ 20) to assess safety.For the purpose of our review, pain pharmacotherapy was defined as including simple analgesics (such as paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs), opioids or opioid-like drugs (such as tramadol), and neuromodulators (including anti-depressants, anti-convulsants, and muscle relaxants). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results and planned to extract data and appraise the risk of bias of included studies. MAIN RESULTS We did not identify any studies meeting our inclusion criteria. Many of the trials of NSAIDs explicitly excluded patients with cardiovascular or renal comorbidities.We did identify one trial that reported evidence in mixed populations (including both rheumatoid arthritis and osteoarthritis) taking either diclofenac or etoricoxib. In this study, the presence of cardiovascular disease increased the likelihood of a further cardiovascular event three-fold. Patients with two or more cardiovascular comorbidities showed a two-fold increased likelihood of adverse cardiovascular events. AUTHORS' CONCLUSIONS There were no trials that specifically compared the efficacy and safety of pain pharmacotherapies for patients with rheumatoid arthritis, with and without comorbid cardiovascular or renal conditions.In the absence of specific evidence in rheumatoid arthritis, current guidelines recommend that NSAIDs be used with caution in the general rheumatoid arthritis population while highlighting the added need for extra vigilance in patients with established cardiovascular disease or risk factors for its development. Current guidelines regarding the use of NSAIDs and opioids in moderate to severe renal impairment should also be applied to the rheumatoid arthritis population.Further research is required to guide clinicians when treating pain in rheumatoid arthritis.
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Affiliation(s)
- Jonathan L Marks
- Department of Rheumatology, Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK, SO16 6YD
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Structural properties of so-called NSAID–phospholipid-complexes. Eur J Pharm Sci 2011; 44:103-16. [DOI: 10.1016/j.ejps.2011.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 06/17/2011] [Accepted: 06/20/2011] [Indexed: 11/23/2022]
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Abdel-Tawab M, Werz O, Schubert-Zsilavecz M. Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clin Pharmacokinet 2011; 50:349-69. [PMID: 21553931 DOI: 10.2165/11586800-000000000-00000] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Non-steroidal anti-inflammatory drug (NSAID) intake is associated with high prevalence of gastrointestinal or cardiovascular adverse effects. All efforts to develop NSAIDs that spare the gastrointestinal tract and the cardiovasculature are still far from achieving a breakthrough. In the last two decades, preparations of the gum resin of Boswellia serrata (a traditional ayurvedic medicine) and of other Boswellia species have experienced increasing popularity in Western countries. Animal studies and pilot clinical trials support the potential of B. serrata gum resin extract (BSE) for the treatment of a variety of inflammatory diseases like inflammatory bowel disease, rheumatoid arthritis, osteoarthritis and asthma. Moreover, in 2002 the European Medicines Agency classified BSE as an 'orphan drug' for the treatment of peritumoral brain oedema. Compared to NSAIDs, it is expected that the administration of BSE is associated with better tolerability, which needs to be confirmed in further clinical trials. Until recently, the pharmacological effects of BSE were mainly attributed to suppression of leukotriene formation via inhibition of 5-lipoxygenase (5-LO) by two boswellic acids, 11-keto-β-boswellic acid (KBA) and acetyl-11-keto-β-boswellic acid (AKBA). These two boswellic acids have also been chosen in the monograph of Indian frankincense in European Pharmacopoiea 6.0 as markers to ensure the quality of the air-dried gum resin exudate of B. serrata. Furthermore, several dietary supplements advertise the enriched content of KBA and AKBA. However, boswellic acids failed to inhibit leukotriene formation in human whole blood, and pharmacokinetic data revealed very low concentrations of AKBA and KBA in plasma, being far below the effective concentrations for bioactivity in vitro. Moreover, permeability studies suggest poor absorption of AKBA following oral administration. In view of these results, the previously assumed mode of action - that is, 5-LO inhibition - is questionable. On the other hand, 100-fold higher plasma concentrations have been determined for β-boswellic acid, which inhibits microsomal prostaglandin E synthase-1 and the serine protease cathepsin G. Thus, these two enzymes might be reasonable molecular targets related to the anti-inflammatory properties of BSE. In view of the results of clinical trials and the experimental data from in vitro studies of BSE, and the available pharmacokinetic and metabolic data on boswellic acids, this review presents different perspectives and gives a differentiated insight into the possible mechanisms of action of BSE in humans. It underlines BSE as a promising alternative to NSAIDs, which warrants investigation in further pharmacological studies and clinical trials.
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Chow R, Armati P, Laakso EL, Bjordal JM, Baxter GD. Inhibitory Effects of Laser Irradiation on Peripheral Mammalian Nerves and Relevance to Analgesic Effects: A Systematic Review. Photomed Laser Surg 2011; 29:365-81. [DOI: 10.1089/pho.2010.2928] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Roberta Chow
- Nerve Research Foundation, Brain and Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Patricia Armati
- Nerve Research Foundation, Brain and Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - E-Liisa Laakso
- Convenor Physiotherapy Programs, School of Physiotherapy and Exercise Science, Griffith Health Institute, Gold Coast Campus, Griffith University, Queensland, Australia
| | - Jan M. Bjordal
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Mollendalsvn, Bergen, Norway
| | - G. David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Potent anti-inflammatory effects of denbinobin mediated by dual inhibition of expression of inducible no synthase and cyclooxygenase 2. Shock 2011; 35:191-7. [PMID: 20661183 DOI: 10.1097/shk.0b013e3181f0e9a8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inducible NO synthase (iNOS) and cyclooxygenase 2 (COX-2) have been suggested to play important roles in various inflammatory diseases. We explored the anti-inflammatory potential of a natural compound, denbinobin (5-hydroxy-3,7-dimethoxy-1,4-phenanthraquinone), by examining its effects on the expression and activity of iNOS and COX-2 in LPS-activated macrophages. Denbinobin markedly decreased the LPS (1 μg/mL)-induced increase in iNOS and COX-2 gene and protein expression, as well as levels of the downstream products NO and prostaglandin E2, in a concentration-dependent manner (0.3-3 μM). In clarifying the mechanisms involved, denbinobin was found not only to inhibit LPS-induced nuclear factor κB (NF-κB) activation, an effect highly correlated with its inhibitory effect on LPS-induced inhibitory κB kinase activation, inhibitory κB degradation, NF-κB phosphorylation, and binding of NF-κB to the κB motif of the iNOS and COX-2 promoters, but also suppressed phosphorylation of mitogen-activated protein kinases. Reporter gene assays and Western blotting revealed that denbinobin significantly suppressed NF-κB activation. Furthermore, denbinobin also downregulated the LPS-mediated CD14/toll-like receptor 4 complex level and TNF-α, IL-1β, and IL-10 mRNA expression. Our results demonstrate that denbinobin exerts potent anti-inflammatory activity, suggesting that it might provide a new therapeutic approach to inflammatory diseases.
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New therapeutic options in rheumatoid arthritis: a focus on interleukin-6 blockade. JOURNAL OF INFUSION NURSING 2011; 34:107-15. [PMID: 21399456 DOI: 10.1097/nan.0b013e31820b4b07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rheumatoid arthritis (RA), a chronic and incurable autoimmune disease characterized by synovial joint damage and systemic inflammation, often leads to substantial disability and reduced quality of life. Biologics, a class of medication that targets key pathways in the RA inflammatory response, have increased therapeutic options in the past decade. Because several biologics are administered intravenously, specialized training in administration and updates on RA management are increasingly needed. This article reviews the pathogenesis of RA and the biologics newly approved by the US Food and Drug Administration, such as the interleukin-6 inhibitor tocilizumab, including their targets in the inflammatory cascade.
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Moreira NB, Artifon EL, Meireles A, Silva LI, Rosa CT, Bertolini GRF. A influência da crioterapia na dor e edema induzidos por sinovite experimental. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi analisar a influência da crioterapia na dor e edema advindos de sinovite induzida em ratos. Foram utilizados 12 ratos, distribuídos em dois grupos: Controle (GC) - submetido à indução de sinovite no joelho direito, e não tratado; e Tratamento (GT) - submetido à sinovite no joelho direito, e tratado com crioterapia. Para induzir a lesão, foi injetado no espaço tíbio-femoral formalina 5%. Para avaliação da dor foi utilizado o teste de incapacidade funcional, que avaliou a dor durante a marcha do animal (tempo de elevação da pata - TEP); e para quantificar o edema foi utilizado um paquímetro metálico, na região da interlinha do joelho. As avaliações ocorreram antes da injeção de formalina (AV1), 1 (AV2) e 2 horas (AV3) após. Após 10 minutos da lesão, o membro posterior direito foi submerso em água com gelo, à 5ºC por 20 minutos. A avaliação do TEP mostrou aumento de 194,03% (AV2) e 169,26% (AV3) para GC; e 134,25% (AV2) e 103,13% (AV3) para GT, com relação à AV1. Na comparação entre os grupos, em AV3, houve diminuição significativa para GT. A avaliação do edema mostrou aumento do diâmetro, para GC de 39,15% (AV2) e 42,39% (AV3); e 27,91% (AV2) e 14,50% (AV3) para GT, tendo como referência AV1; sendo que apenas GT apresentou diminuição significativa entre AV2 e AV3. Conclui-se que os efeitos em curto prazo, da crioterapia, foram significativos para reduzir a dor e edema, em ratos submetidos à indução de sinovite.
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Costantino C, Kwarecki J, Samokhin AV, Mautone G, Rovati S. Diclofenac epolamine plus heparin plaster versus diclofenac epolamine plaster in mild to moderate ankle sprain: a randomized, double-blind, parallel-group, placebo-controlled, multicentre, phase III trial. Clin Drug Investig 2011; 31:15-26. [PMID: 20923251 DOI: 10.2165/11585890-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND In general sports, ankle sprain is the most frequently reported ankle injury and can cause chronic lateral ankle pain and tenderness. Treatment with NSAIDs is preferred, and several topical NSAID formulations are now available, helping to avoid the systemic adverse events typically associated with oral preparations. OBJECTIVE To compare the efficacy and tolerability of a newly developed fixed-dose diclofenac epolamine (diclofenac hydroxyethylpyrrolidine, DHEP)/heparin plaster (Flectoparin® Tissugel) with that of a DHEP (Flector EP Tissugel®) or placebo plaster in the treatment of mild to moderate ankle sprain in adults. METHODS This was a randomized, double-blind, parallel-group, placebo-controlled, multicentre, phase III study conducted in the emergency medical centres of hospitals or private clinics in Europe. Outpatients aged 18-65 years who had suffered an acute ankle sprain (O'Donoghue grade I or II in severity, with external lateral ligament involvement) within the previous 48 hours and had peri-malleolar oedema were eligible for inclusion. A total of 430 patients were randomized to receive a DHEP/heparin 1.3%/5600 IU (n = 142), DHEP 1.3% (n = 146) or placebo (n = 142) plaster, applied once daily to the injured ankle for a total of 7 days. The primary endpoint was the mean change from baseline in pain on movement on day 3, as measured by a visual analogue scale (VAS). RESULTS The DHEP/heparin plaster was associated with a significantly (p = 0.002) greater mean reduction from baseline in pain on movement after 3 days of treatment than the DHEP plaster (-24.2 vs -18.8 mm VAS), with each active treatment providing significantly (p ≤ 0.005) greater pain relief than placebo (-13.7 mm VAS). Both DHEP/heparin and DHEP were also effective in relieving other measures of pain, with DHEP/heparin recipients experiencing significantly less daily pain while leaning on the injured limb than DHEP recipients (p < 0.001). In addition, oedema was reduced to a significantly greater extent with DHEP/heparin than with placebo (day 7 only; p = 0.012). The DHEP/heparin plaster and DHEP plaster were both well tolerated, with adverse event profiles similar to that of placebo. Local adverse events were infrequent and generally mild in severity and there were no systemic adverse effects. CONCLUSION The fixed-dose DHEP/heparin plaster is effective and has advantages over the DHEP plaster in relieving pain, and possibly also swelling, associated with mild to moderate acute ankle sprains with oedema in adults.
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Affiliation(s)
- Cosimo Costantino
- Sezione di Ortopedia Traumatologia e Riabilitazione Funzionale, Dipartimento di Scienze Chirurgiche, Azienda Ospedaliera Università degli Studi di Parma, Parma, Italy
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Goldstein JL, Jungwirthová A, David J, Spindel E, Bouchner L, Pešek F, Searle S, Skopek J, Grim J, Ulč I, Sewell KL. Clinical trial: endoscopic evaluation of naproxen etemesil, a naproxen prodrug, vs. naproxen - a proof-of-concept, randomized, double-blind, active-comparator study. Aliment Pharmacol Ther 2010; 32:1091-101. [PMID: 20804454 DOI: 10.1111/j.1365-2036.2010.04442.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs are associated with upper gastrointestinal mucosal injury. Naproxen etemesil is a lipophilic, non-acidic, inactive prodrug of naproxen that is hydrolysed to pharmacologically active naproxen once absorbed. We hypothesized that with lesser topical exposure to naproxen from the prodrug, there would be reduced gastroduodenal mucosal injury compared with naproxen. AIM To compare the degree of endoscopic mucosal damage of naproxen etemesil vs. naproxen. METHODS This multicentre, randomized, double-blind, double-dummy trial compared oral naproxen etemesil 1200 mg twice daily (n = 61) with naproxen 500 mg twice daily (n = 59) for 7.5 days in 120 healthy subjects (45-70 years; mean 51 years; 58% female) with baseline total modified gastroduodenal Lanza score ≤ 2 (no erosions/ulcers) on endoscopy. The primary endpoint was mean total modified gastroduodenal Lanza score on day 7. A secondary endpoint was incidence of gastric ulcers. RESULTS The day 7 mean total modified gastroduodenal Lanza score was 2.8 ± 1.7 for naproxen etemesil vs. 3.5 ± 2.0 for naproxen (P = 0.03), and significantly fewer naproxen etemesil-treated subjects (3.3%) developed gastric ulcers compared with naproxen-treated subjects (15.8%) (P = 0.02). CONCLUSION In this first proof-of-concept study, naproxen etemesil was associated with significantly lower gastroduodenal mucosal injury compared with naproxen after 7 days of exposure ( CLINICAL TRIAL NUMBER NCT00750243).
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Affiliation(s)
- J L Goldstein
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Flachsmann F, Schellhaas K, Moya CE, Jacobs RS, Fenical W. Synthetic pseudopterosin analogues: A novel class of antiinflammatory drug candidates. Bioorg Med Chem 2010; 18:8324-33. [PMID: 21041093 DOI: 10.1016/j.bmc.2010.09.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 11/15/2022]
Abstract
The synthesis and in vivo anti-inflammatory activity of a series of pseudopterosin analogues are presented. Synthetic tricyclic catechol aglycons with different substitution patterns were monofucosylated or -xylosylated. Anti-inflammatory activity was conserved over a wide range of structural modifications. The most active synthetic compound 33 reduced phorbol myristate acetate (PMA)-induced inflammation in the mouse ear by 72% at 50 μg/ear. This corresponds to 80% of the activity of natural pseudopterosin A.
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Affiliation(s)
- Felix Flachsmann
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California at San Diego, La Jolla, 92093-0204, USA
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Tielemans MM, Eikendal T, Jansen JBMJ, van Oijen MGH. Identification of NSAID users at risk for gastrointestinal complications: a systematic review of current guidelines and consensus agreements. Drug Saf 2010; 33:443-53. [PMID: 20486727 DOI: 10.2165/11534590-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
NSAIDs are among the most often used drugs worldwide. Numerous NSAID users are at risk for developing gastrointestinal complications. The purpose of this review was to identify and stratify risk factors for gastrointestinal complications in NSAID users documented in guidelines and consensus agreements, and to collect recommendations regarding over-the-counter (OTC) NSAID use. To facilitate this, a PubMed search from 1 January 1999 until 1 March 2009 was performed, resulting in the inclusion of nine English-language guidelines in our analysis. Risk factors were defined as 'definite' if mentioned in all guidelines; otherwise they were defined as 'controversial' risk factors. 'Definite' risk factors were a history of (complicated) peptic ulcer disease, older age (cut-off range 60-75 years), concomitant anticoagulant or corticosteroid use and multiple NSAID use, including low-dose aspirin (acetylsalicylic acid). 'Controversial' risk factors were high-dose NSAID use, concomitant clopidogrel or selective serotonin reuptake inhibitor use, a history of gastrointestinal symptoms, rheumatoid arthritis disability and cardiovascular disease. Infection with Helicobacter pylori was identified as an additive risk factor. Risk factors in OTC NSAID users were difficult to identify in the current literature. Risk factors were not all uniformly present in analysed guidelines and consensus agreements. We identified a history of (complicated) peptic ulcer disease, older age, concomitant anticoagulant or corticosteroid use and multiple NSAID use, including low-dose aspirin, as definite gastrointestinal risk factors in NSAID users.
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Affiliation(s)
- Merel M Tielemans
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Abstract
Athletes often seek artificial means to gain advantage and prolong participation when competing. This often involves taking naturally occurring or chemically synthesized compounds. The World Anti-Doping Agency does not prohibit the use of nonsteroidal anti-inflammatory drugs (NSAIDs) because these agents are not performance enhancing, and their analgesic and anti-inflammatory effects are at best performance enabling. Consequently, athletes have relatively unrestricted access to NSAIDs, which are readily available as over-the-counter drugs. However, concern has been raised on athletes' prophylactic use of these agents. Data from many sporting fields have consistently demonstrated that many individuals self-administer NSAIDs prior to athletic participation to prevent pain and inflammation before it occurs. However, scientific evidence for this approach is currently lacking, and athletes should be aware of the potential risks in using NSAIDs as a prophylactic agent. These agents are not benign, and can produce significant side effects, including gastrointestinal and cardiovascular conditions, as well as musculoskeletal and renal side effects. The latter side effects appear paradoxical to the rationale for prophylactic use of NSAIDs. This article discusses current observations regarding athlete use of NSAIDs, and the possible benefits and potential risks of their use.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA.
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48
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Croom KF, Siddiqui MAA. Etoricoxib: a review of its use in the symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis. Drugs 2009; 69:1513-32. [PMID: 19634927 DOI: 10.2165/00003495-200969110-00008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Etoricoxib is a selective cyclo-oxygenase (COX)-2 inhibitor, approved in Europe for the symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis. Etoricoxib provided similar symptomatic relief to nonselective NSAIDs in patients with these conditions, and to celecoxib in patients with osteoarthritis. The drug was associated with fewer uncomplicated upper gastrointestinal (GI) adverse events than nonselective NSAIDs, and was noninferior to diclofenac in terms of the rate of thrombotic cardiovascular (CV) events. Etoricoxib may be considered as a treatment option for patients requiring NSAID therapy, particularly those at risk of upper GI events, after careful consideration of significant risk factors for CV events (including uncontrolled hypertension). As with all NSAIDs, the potential GI and CV risks of treatment with etoricoxib should be weighed against the potential benefits in individual patients, and it should be administered at the lowest effective dose for as short a duration as possible.
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49
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Scheiman JM. Balancing risks and benefits of cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs. Gastroenterol Clin North Am 2009; 38:305-14. [PMID: 19446260 DOI: 10.1016/j.gtc.2009.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Choosing NSAID therapy remains confusing and controversial-the challenge for the clinician is to sum all the risks as well as analgesic and anti-inflammatory efficacy. COX-2 inhibitors are an important scientific advance in pain therapy, and using them in a safe and cost-effective manner is possible when all the competing risks are carefully weighed.
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Affiliation(s)
- James M Scheiman
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan School of Medicine, 3912 Taubman Center SPC 5362, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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50
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Kraus S, Arber N. Rofecoxib and cardiovascular adverse effects: New insights. CURRENT COLORECTAL CANCER REPORTS 2009. [DOI: 10.1007/s11888-009-0001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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