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Owolabi P, Adam Y, Adebiyi E. Personalizing medicine in Africa: current state, progress and challenges. Front Genet 2023; 14:1233338. [PMID: 37795248 PMCID: PMC10546210 DOI: 10.3389/fgene.2023.1233338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Personalized medicine has been identified as a powerful tool for addressing the myriad of health issues facing different health systems globally. Although recent studies have expanded our understanding of how different factors such as genetics and the environment play significant roles in affecting the health of individuals, there are still several other issues affecting their translation into personalizing health interventions globally. Since African populations have demonstrated huge genetic diversity, there is a significant need to apply the concepts of personalized medicine to overcome various African-specific health challenges. Thus, we review the current state, progress, and challenges facing the adoption of personalized medicine in Africa with a view to providing insights to critical stakeholders on the right approach to deploy.
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Affiliation(s)
- Paul Owolabi
- Covenant Applied Informatics and Communication, Africa Centre of Excellence (CApIC-ACE), Covenant University, Ota, Ogun State, Nigeria
- Department of Computer and Information Science, Covenant University, Ota, Ogun State, Nigeria
| | - Yagoub Adam
- Covenant University Bioinformatics Research (CUBRe), Covenant University, Ota, Ogun State, Nigeria
| | - Ezekiel Adebiyi
- Covenant Applied Informatics and Communication, Africa Centre of Excellence (CApIC-ACE), Covenant University, Ota, Ogun State, Nigeria
- Department of Computer and Information Science, Covenant University, Ota, Ogun State, Nigeria
- Covenant University Bioinformatics Research (CUBRe), Covenant University, Ota, Ogun State, Nigeria
- Applied Bioinformatics Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kessels R, Moerbeek M. A comparison of the multilevel MIMIC model to the multilevel regression and mixed ANOVA model for the estimation and testing of a cross-level interaction effect: A simulation study. Biom J 2023; 65:e2200112. [PMID: 37068180 DOI: 10.1002/bimj.202200112] [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: 04/13/2022] [Revised: 02/24/2023] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
When observing data on a patient-reported outcome measure in, for example, clinical trials, the variables observed are often correlated and intended to measure a latent variable. In addition, such data are also often characterized by a hierarchical structure, meaning that the outcome is repeatedly measured within patients. To analyze such data, it is important to use an appropriate statistical model, such as structural equation modeling (SEM). However, researchers may rely on simpler statistical models that are applied to an aggregated data structure. For example, correlated variables are combined into one sum score that approximates a latent variable. This may have implications when, for example, the sum score consists of indicators that relate differently to the latent variable being measured. This study compares three models that can be applied to analyze such data: the multilevel multiple indicators multiple causes (ML-MIMIC) model, a univariate multilevel model, and a mixed analysis of variance (ANOVA) model. The focus is on the estimation of a cross-level interaction effect that presents the difference over time on the patient-reported outcome between two treatment groups. The ML-MIMIC model is an SEM-type model that considers the relationship between the indicators and the latent variable in a multilevel setting, whereas the univariate multilevel and mixed ANOVA model rely on sum scores to approximate the latent variable. In addition, the mixed ANOVA model uses aggregated second-level means as outcome. This study showed that the ML-MIMIC model produced unbiased cross-level interaction effect estimates when the relationships between the indicators and the latent variable being measured varied across indicators. In contrast, under similar conditions, the univariate multilevel and mixed ANOVA model underestimated the cross-level interaction effect.
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Affiliation(s)
- Rob Kessels
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
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Pfaus JG. Politics of Sexual Desire. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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da Silva Lara LA, Rufino AC, Oliveira FF, Rossato S, Borges CS, Reis RM. Female sexual dysfunctions: an overview on the available therapeutic interventions. Minerva Obstet Gynecol 2022; 74:249-260. [PMID: 35147017 DOI: 10.23736/s2724-606x.22.04966-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
INTRODUCTION There are different types of female sexual dysfunctions (FSDs), and FSD in general has a high prevalence worldwide. Studies of FSD should consider it as a multifactorial disorder that has biological, psychological, environmental, and relational aspects. In this review we discuss the available therapeutic interventions for FSD. EVIDENCE ACQUISITION For the current narrative review the PubMed database was searched to identify all publications up to 30 March 2021 that were systematic reviews and meta-analyses which examined therapeutic interventions for FSDs based on the diagnostic classifications of ICD-10 and ICD-11. EVIDENCE SYNTHESIS Thirty systematic reviews and meta-analyses were included in this review. Hormone therapy (HT) and testosterone are effective to improve sexual desire in menopausal women. In these women HT and ospemiphene may improve pain during intercourse. Flibanserin may improve sexual desire and may reduce desire-related distress in premenopausal women. Bremelanotide is effective to improve desire, arousal, and orgasm scores. Evidence are still limited on the efficacy of psychoactive drugs, phosphodiesterase type 5 (PDE5), oxytocin, herbal drugs, and tibolone to treat FSDs. Psychological interventions such as cognitive-behavior therapy, mindfulness training, sensate focus, bibliotherapy are effective for the management of several different FSDs. CONCLUSIONS The management of FSDs may require multidisciplinary and interdisciplinary approaches. Pharmacological and nonpharmacological interventions appears to have potential as a treatment for FSDs, but there are currently no gold standards regarding recommended treatment modalities, and the duration, frequency, and intensity of therapy sessions.
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Affiliation(s)
- Lucia A da Silva Lara
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil -
| | - Andrea C Rufino
- Faculty of Medicine, State University of Piauí, Piauí, NE, Brazil
| | - Flávia F Oliveira
- Endometriosis Sector, Faculty of Medicine, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Serena Rossato
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Charles S Borges
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosana M Reis
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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Edinoff AN, Sanders NM, Lewis KB, Apgar TL, Cornett EM, Kaye AM, Kaye AD. Bremelanotide for Treatment of Female Hypoactive Sexual Desire. Neurol Int 2022; 14:75-88. [PMID: 35076581 PMCID: PMC8788464 DOI: 10.3390/neurolint14010006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Hypoactive sexual desire disorder (HSDD) is a persistent deficiency or absence of sexual fantasies and desire resulting in significant distress or interpersonal difficulty. Women with this disorder may display a lack of motivation for sexual activity, reduced responsiveness to erotic cues, a loss of interest during sexual activity, and avoidance of situations that could lead to sexual activity. The pathophysiology of HSDD is thought to be centered around inhibitory and excitatory hormones, neurotransmitters, and specific brain anatomy. Due to the multifactorial nature of HSDD, treatment can be complex and must attempt to target the biological and psychosocial aspects of the disorder. Bremelanotide is a melanocortin receptor agonist and has been recently approved by the FDA to treat HSDD. Bremelanotide is administered intranasally or as a subcutaneous injection. The recommended dosage of bremelanotide is 1.75 mg injected subcutaneously in the abdomen or thigh at least 45 min before sexual activity. Studies showed improvements in desire, arousal, and orgasm scores when 1.75 mg of bremelanotide was administered before sexual activity compared to a placebo. Bremelanotide is a promising way to treat HSDD.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Nicole M. Sanders
- Shreveport School of Medicine, Louisiana State University, Shreveport, LA 71103, USA; (N.M.S.); (K.B.L.)
| | - Kyle B. Lewis
- Shreveport School of Medicine, Louisiana State University, Shreveport, LA 71103, USA; (N.M.S.); (K.B.L.)
| | - Tucker L. Apgar
- Department of Chemical Biology and Biochemistry, Vanderbilt University, Nashville, TN 37235, USA;
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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Balon R. Debate of Basson's Mode of Sexual Response: Response to responses. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:20-22. [PMID: 34775910 DOI: 10.1080/0092623x.2021.1998273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Richard Balon
- Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University, Detroit, MI, USA
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Brotto LA, Graham CA. Is Basson's Model of Sexual Response Relevant? Yes, and so are other validated models of sexual response: A commentary on Balon (2021). JOURNAL OF SEX & MARITAL THERAPY 2021; 48:13-16. [PMID: 34772329 DOI: 10.1080/0092623x.2021.1918301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lori A Brotto
- University of British Columbia, Obstetrics and Gynaecology, Vancouver, British Columbia, Canada
| | - Cynthia A Graham
- University of Southampton, Psychology, Shackleton Bldg, Southampton, United Kingdom of Great Britain and Northern Ireland
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Kessels R, Moerbeek M, Bloemers J, van der Heijden PGM. A multilevel structural equation model for assessing a drug effect on a patient-reported outcome measure in on-demand medication data. Biom J 2021; 63:1652-1672. [PMID: 34270801 PMCID: PMC9292391 DOI: 10.1002/bimj.202100046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/07/2021] [Accepted: 06/19/2021] [Indexed: 11/08/2022]
Abstract
We analyze data from a clinical trial investigating the effect of an on-demand drug for women with low sexual desire. These data consist of a varying number of measurements/events across patients of when the drug was taken, including data on a patient-reported outcome consisting of five items measuring an unobserved construct (latent variable). Traditionally, these data are aggregated prior to analysis by composing one sum score per event and averaging this sum score over all observed events. In this paper, we explain the drawbacks of this aggregating approach. One drawback is that these averages have different standard errors because the variance of the underlying events differs between patients and because the number of events per patient differs. Another drawback is the implicit assumption that all items have equal weight in relation to the latent variable being measured. We propose a multilevel structural equation model, treating the events (level 1) as nested observations within patients (level 2), as alternative analysis method to overcome these drawbacks. The model we apply includes a factor model measuring a latent variable at the level of the event and at the level of the patient. Then, in the same model, the latent variables are regressed on covariates to assess the drug effect. We discuss the inferences obtained about the efficacy of the on-demand drug using our proposed model. We further illustrate how to test for measurement invariance across grouping covariates and levels using the same model.
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Affiliation(s)
- Rob Kessels
- Emotional Brain BV, Almere, The Netherlands.,Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Jos Bloemers
- Emotional Brain BV, Almere, The Netherlands.,Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Peter G M van der Heijden
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands.,Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
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Höhle D, van Rooij K, Bloemers J, Pfaus JG, Michiels F, Janssen P, Claassen E, Tuiten A. A survival of the fittest strategy for the selection of genotypes by which drug responders and non-responders can be predicted in small groups. PLoS One 2021; 16:e0246828. [PMID: 33667227 PMCID: PMC7935233 DOI: 10.1371/journal.pone.0246828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Phenotype Prediction Scores (PPS) might be powerful tools to predict traits or the efficacy of treatments based on combinations of Single-Nucleotide Polymorphism (SNPs) in large samples. We developed a novel method to produce PPS models for small samples sizes. The set of SNPs is first filtered on those known to be relevant in biological pathways involved in a clinical condition, and then further filtered repeatedly in a survival strategy to select stabile positive/negative risk alleles. This method is applied on Female Sexual Interest/Arousal Disorder (FSIAD), for which two subtypes has been proposed: 1) a relatively insensitive excitatory system in the brain for sexual cues, and 2) a dysfunctional activation of brain mechanisms for sexual inhibition. A double-blind, randomized, placebo-controlled cross-over experiment was conducted on 129 women with FSIAD. The women received three different on-demand drug-combination treatments during 3 two-week periods: testosterone (0.5 mg) + sildenafil (50 mg), testosterone (0.5 mg) + buspirone (10 mg), or matching placebos. The resulted PPS were independently validated on patient-level and group-level. The AUC scores for T+S of the derivation set was 0.867 (95% CI = 0.796-0.939; p<0.001) and was 0.890 (95% CI = 0.778-1.000; p<0.001) on the validation set. For T+B the AUC of the derivation set was 0.957 (95% CI = 0.921-0.992; p<0.001) and 0.869 (95% CI = 0.746-0.992; p<0.001) for the validation set. Both formulas could reliably predict for each drug who benefit from the on-demand drugs and could therefore be useful in clinical practice.
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Affiliation(s)
| | - Kim van Rooij
- Emotional Brain B.V., Almere, The Netherlands
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Jos Bloemers
- Emotional Brain B.V., Almere, The Netherlands
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - James G Pfaus
- Centro de Investigaciones Cerebrales, Xalapa, Mexico
| | - Frits Michiels
- Chemistry and Life Sciences, V.O. Patients & Trademarks, Amsterdam, The Netherlands
| | - Paddy Janssen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Hospital Pharmacy, VieCuri Medical Center Venlo, Venlo, The Netherlands
| | - Eric Claassen
- Emotional Brain B.V., Almere, The Netherlands
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Rao TSS, Andrade C. Personalized Pharmacotherapy for Women With Sexual Interest/Arousal Disorder. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831820973142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Abstract
PURPOSE OF REVIEW Recently in October 2019 a Global Consensus Position on the use of Testosterone Therapy for Women was published. The use of testosterone and other agents for female sexual dysfunction (FSD) is an important topic for the urologist focusing on sexual health. This review describes the known causes for FSD, and discusses the role of androgens in this disorder, the evidence for using testosterone treatment, and other current and emerging therapies. RECENT FINDINGS A recent meta-analysis, published in The Lancet Diabetes & Endocrinology evaluated a total of 36 randomized control trials spanning 1990-2018 and includes a total of 8480 patients. The primary findings were that testosterone therapy (TTh) increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image when compared with either a placebo or drug-control (e.g., estrogen ± progestogen). In addition, TTh reduced sexual concerns and distress in postmenopausal women. Side effects included an increase in weight, acne, and hair growth, but there was no increase in serious adverse events. Importantly, TTh duration was greater than 12 weeks in all randomized control trials included in this meta-analysis. SUMMARY TTh is effective to treat FSD in postmenopausal women. More data is required to evaluate the long-term safety data on the effects of TTh on cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Juliana M. Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Ekta Kapoor
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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Multilevel analyses of on-demand medication data, with an application to the treatment of Female Sexual Interest/Arousal Disorder. PLoS One 2019; 14:e0221063. [PMID: 31415608 PMCID: PMC6695215 DOI: 10.1371/journal.pone.0221063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
Data from clinical trials investigating on-demand medication often consist of an intentionally varying number of measurements per patient. These measurements are often observations of discrete events of when the medication was taken, including for example data on symptom severity. In addition to the varying number of observations between patients, the data have another important feature: they are characterized by a hierarchical structure in which the events are nested within patients. Traditionally, the observed events of patients are aggregated into means and subsequently analyzed using, for example, a repeated measures ANOVA. This procedure has drawbacks. One drawback is that these patient means have different standard errors, first, because the variance of the underlying events differs between patients and second, because the number of events per patient differs. In this paper, we argue that such data should be analyzed by applying a multilevel analysis using the individual observed events as separate nested observations. Such a multilevel approach handles this drawback and it also enables the examination of varying drug effects across patients by estimating random effects. We show how multilevel analyses can be applied to on-demand medication data from a clinical trial investigating the efficacy of a drug for women with low sexual desire. We also explore linear and quadratic time effects that can only be performed when the individual events are considered as separate observations and we discuss several important statistical topics relevant for multilevel modeling. Taken together, the use of a multilevel approach considering events as nested observations in these types of data is advocated as it is more valid and provides more information than other (traditional) methods.
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Weiss RV, Hohl A, Athayde A, Pardini D, Gomes L, de Oliveira M, Meirelles R, Clapauch R, Spritzer PM. Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:190-198. [PMID: 31340240 PMCID: PMC10522198 DOI: 10.20945/2359-3997000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize current evidence regarding testosterone treatment for women with low sexual desire. MATERIALS AND METHODS The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. RESULTS Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. CONCLUSION Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8.
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Affiliation(s)
- Rita V. Weiss
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Alexandre Hohl
- Universidade Federal de Santa CatarinaDepartamento de Medicina InternaHospital UniversitárioUniversidade Federal de Santa CatarinaFlorianópolisSCBrasilServiço de Endocrinologia e Metabolismo, Departamento de Medicina Interna, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Amanda Athayde
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Dolores Pardini
- Universidade Federal de São PauloUniversidade Federal de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Larissa Gomes
- Universidade de São PauloFaculdade de MedicinaHospital de ClínicasUniversidade de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Faculdade de Medicina, Hospital de Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Monica de Oliveira
- Instituto de Medicina Integral Professor Fernando FigueiraInstituto de Medicina Integral Professor Fernando FigueiraRecifePEBrasilInstituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | - Ricardo Meirelles
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Ruth Clapauch
- Departamento de Fisiologia Endócrina e FisiologiaLaboratório de Pesquisas Clínicas e Experimentais em Biologia VascularRio de JaneiroRJBrasilDepartamento de Fisiologia Endócrina e Fisiologia e Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BIOVASC), Rio de Janeiro, RJ, Brasil
| | - Poli Mara Spritzer
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreDepartamento de FisiologiaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilUnidade de Endocrinologia Ginecológica, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre e Departamento de Fisiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Miller MK, Smith JR, Norman JJ, Clayton AH. Expert opinion on existing and developing drugs to treat female sexual dysfunction. Expert Opin Emerg Drugs 2018; 23:223-230. [PMID: 30251897 DOI: 10.1080/14728214.2018.1527901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a highly prevalent, yet commonly underdiagnosed and undertreated condition. This paper reviews the diagnostic terminology for FSD, and basic sexual physiology in women. The Food and Drug Administration (FDA) approved drugs for FSD are discussed, followed by investigational drugs for FSD currently in phase 2 or 3 clinical trials, reasons for failure of drug development, and potential future drug targets. Areas covered: A literature review was conducted for available treatments for FSD: flibanserin, estrogen, ospemifene and prasterone. Potential treatments are assessed, as was the Pharmaprojects database which includes clinical trial information. Testosterone, bremelanotide, bupropion-trazodone, PDE-5 inhibitors, prostaglandins, tibolone and combination therapies, and the theoretical basis of potential drug targets are discussed. Expert opinion: The lack of established endpoints for phase 3 studies of FSD has impeded approval of new treatments, and required additional studies for validation, resulting in proposed changes to the FDA draft guidance for FSD clinical trials in October 2016. Current DSM-5 diagnostic nosology also fails to capture the full range of symptomology. Several promising compounds have shown no movement for several years limiting women's options. Overcoming socio-cultural bias against women's sexual and reproductive health will be critical in the approval of new treatments for FSD.
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Heany SJ, Bethlehem RAI, van Honk J, Bos PA, Stein DJ, Terburg D. Effects of testosterone administration on threat and escape anticipation in the orbitofrontal cortex. Psychoneuroendocrinology 2018; 96:42-51. [PMID: 29902666 DOI: 10.1016/j.psyneuen.2018.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 01/28/2023]
Abstract
Recent evidence suggests that the steroid hormone testosterone can decrease the functional coupling between orbitofrontal cortex (OFC) and amygdala. Theoretically this decoupling has been linked to a testosterone-driven increase of goal-directed behaviour in case of threat, but this has never been studied directly. Therefore, we placed twenty-two women in dynamically changing situations of escapable and inescapable threat after a within-subject placebo controlled testosterone administration. Using functional magnetic resonance imaging (fMRI) we provide evidence that testosterone activates the left lateral OFC (LOFC) in preparation of active goal-directed escape and decouples this OFC area from a subcortical threat system including the central-medial amygdala, hypothalamus and periaqueductal gray. This LOFC decoupling was specific to threatening situations, a point that was further emphasized by an absence of such decoupling in a second experiment focused on resting-state connectivity. These results not only confirm that testosterone administration decouples the LOFC from the subcortical threat system, but also show that this is specifically the case in response to acute threat, and ultimately leads to an increase in LOFC activity when the participant prepares a goal-directed action to escape. Together these results for the first time provide a detailed understanding of functional brain alterations induced by testosterone under threat conditions, and corroborate and extend the view that testosterone prepares the brain for goal-directed action in case of threat.
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Affiliation(s)
- Sarah J Heany
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Richard A I Bethlehem
- Autism Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom
| | - Jack van Honk
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Peter A Bos
- Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; MRC Unit on Anxiety & Stress Disorders, University of Cape Town, South Africa
| | - David Terburg
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Department of Experimental Psychology, Utrecht University, The Netherlands.
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17
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Charest M, Kleinplatz PJ. A Review of Recent Innovations in the Treatment of Low Sexual Desire. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0171-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Tuiten A, Michiels F, Böcker KB, Höhle D, van Honk J, de Lange RP, van Rooij K, Kessels R, Bloemers J, Gerritsen J, Janssen P, de Leede L, Meyer JJ, Everaerd W, Frijlink HW, Koppeschaar HP, Olivier B, Pfaus JG. Genotype scores predict drug efficacy in subtypes of female sexual interest/arousal disorder: A double-blind, randomized, placebo-controlled cross-over trial. ACTA ACUST UNITED AC 2018; 14:1745506518788970. [PMID: 30016917 PMCID: PMC6052493 DOI: 10.1177/1745506518788970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Attempts to develop a drug treatment for female sexual interest/arousal disorder
have so far been guided by the principle of ‘one size fits all’, and have failed
to acknowledge the complexity of female sexuality. Guided by personalized
medicine, we designed two on-demand drugs targeting two distinct hypothesized
causal mechanisms for this sexual disorder. The objective of this study was to
design and test a novel procedure, based on genotyping, that predicts which of
the two on-demand drugs will yield a positive treatment response. In a
double-blind, randomized, placebo-controlled cross-over experiment, 139 women
with female sexual interest/arousal disorder received three different on-demand
drug-combination treatments during three 2-week periods: testosterone
0.5 mg + sildenafil 50 mg, testosterone 0.5 mg + buspirone 10 mg, and matching
placebo. The primary endpoint was change in satisfactory sexual events.
Subjects’ genetic profile was assessed using a microarray chip that measures
300,000 single-nucleotide polymorphisms. A preselection of single-nucleotide
polymorphisms associated with genes that are shown to be involved in sexual
behaviour were combined into a Phenotype Prediction Score. The Phenotype
Prediction Score demarcation formula was developed and subsequently validated on
separate data sets. Prediction of drug-responders with the Phenotype Prediction
Score demarcation formula gave large effect sizes (d = 0.66 through 1.06) in the
true drug-responders, and medium effect sizes (d = 0.51 and d = 0.47) in all
patients (including identified double, and non-responders). Accuracy,
sensitivity, specificity, positive predictive value, and negative predictive
value of the Phenotype Prediction Score demarcation formula were all between
0.78 and 0.79, and thus sufficient. The resulting Phenotype Prediction Score was
validated and shown to effectively and reliably predict which women would
benefit from which on-demand drug, and could therefore also be useful in
clinical practice, as a companion diagnostic establishing the way to a true
personalized medicine approach.
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Affiliation(s)
| | - Frits Michiels
- 2 Chemistry and Life Sciences, V.O. Patients & Trademarks, Amsterdam, The Netherlands
| | | | - Daniël Höhle
- 3 Alan Turing Institute Almere, Almere, The Netherlands
| | - Jack van Honk
- 4 Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.,5 Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,6 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Kim van Rooij
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Rob Kessels
- 1 Emotional Brain BV, Almere, The Netherlands
| | - Jos Bloemers
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Gerritsen
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Paddy Janssen
- 8 Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,9 Department of Central Hospital Pharmacy, Viecuri Hospital, Venlo, The Netherlands
| | - Leo de Leede
- 10 Exelion Bio-Pharmaceutical Consultancy B.V., Waddinxveen, The Netherlands
| | - John-Jules Meyer
- 3 Alan Turing Institute Almere, Almere, The Netherlands.,11 Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Walter Everaerd
- 12 Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Henderik W Frijlink
- 13 Research Group of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherland
| | | | - Berend Olivier
- 7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands.,14 Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,15 Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - James G Pfaus
- 16 Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
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19
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Simon JA, Davis SR, Althof SE, Chedraui P, Clayton AH, Kingsberg SA, Nappi RE, Parish SJ, Wolfman W. Sexual well-being after menopause: An International Menopause Society White Paper. Climacteric 2018; 21:415-427. [DOI: 10.1080/13697137.2018.1482647] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J. A. Simon
- IntimMedicine Specialists; George Washington University, Washington, DC, USA
| | - S. R. Davis
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S. E. Althof
- Center for Marital and Sexual Health of South Florida, West Palm Beach, FL, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - P. Chedraui
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - A. H. Clayton
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - S. A. Kingsberg
- Division of Behavioral Medicine, Department of Obstetrics & Gynecology, University Hospitals Cleveland Medical Center and Departments of Reproductive Biology and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - S. J. Parish
- Weill Cornell Medical College, New York, NY, USA
| | - W. Wolfman
- Menopause Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
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