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Peng X, Li X, Xie B, Lai Y, Sosnik A, Boucetta H, Chen Z, He W. Gout therapeutics and drug delivery. J Control Release 2023; 362:728-754. [PMID: 37690697 DOI: 10.1016/j.jconrel.2023.09.011] [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: 05/28/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Gout is a common inflammatory arthritis caused by persistently elevated uric acid levels. With the improvement of people's living standards, the consumption of processed food and the widespread use of drugs that induce elevated uric acid, gout rates are increasing, seriously affecting the human quality of life, and becoming a burden to health systems worldwide. Since the pathological mechanism of gout has been elucidated, there are relatively effective drug treatments in clinical practice. However, due to (bio)pharmaceutical shortcomings of these drugs, such as poor chemical stability and limited ability to target the pathophysiological pathways, traditional drug treatment strategies show low efficacy and safety. In this scenario, drug delivery systems (DDS) design that overcome these drawbacks is urgently called for. In this review, we initially describe the pathological features, the therapeutic targets, and the drugs currently in clinical use and under investigation to treat gout. We also comprehensively summarize recent research efforts utilizing lipid, polymeric and inorganic carriers to develop advanced DDS for improved gout management and therapy.
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Affiliation(s)
- Xiuju Peng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Xiaotong Li
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Bing Xie
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Yaoyao Lai
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Alejandro Sosnik
- Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa 3200003, Israel
| | - Hamza Boucetta
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
| | - Wei He
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China; Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
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2
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Basu P, Maier C, Averitt DL, Basu A. NLR family pyrin domain containing 3 (NLRP3) inflammasomes and peripheral neuropathic pain - Emphasis on microRNAs (miRNAs) as important regulators. Eur J Pharmacol 2023; 955:175901. [PMID: 37451423 DOI: 10.1016/j.ejphar.2023.175901] [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: 02/18/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Neuropathic pain is caused by the lesion or disease of the somatosensory system and can be initiated and/or maintained by both central and peripheral mechanisms. Nerve injury leads to neuronal damage and apoptosis associated with the release of an array of pathogen- or damage-associated molecular patterns to activate inflammasomes. The activation of the NLR family pyrin domain containing 3 (NLRP3) inflammasome contributes to neuropathic pain and may represent a novel target for pain therapeutic development. In the current review, we provide an up-to-date summary of the recent findings on the involvement of NLRP3 inflammasome in modulating neuropathic pain development and maintenance, focusing on peripheral neuropathic conditions. Here we provide a detailed review of the mechanisms whereby NLRP3 inflammasomes contribute to neuropathic pain via (1) neuroinflammation, (2) apoptosis, (3) pyroptosis, (4) proinflammatory cytokine release, (5) mitochondrial dysfunction, and (6) oxidative stress. We then present the current research literature reporting on the antinociceptive effects of several natural products and pharmacological interventions that target activation, expression, and/or regulation of NLRP3 inflammasome. Furthermore, we emphasize the effects of microRNAs as another regulator of NLRP3 inflammasome. In conclusion, we summarize the possible caveats and future perspectives that might provide successful therapeutic approaches against NLRP3 inflammasome for treating or preventing neuropathic pain conditions.
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Affiliation(s)
- Paramita Basu
- Pittsburgh Center for Pain Research, The Pittsburgh Project to End Opioid Misuse, Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| | - Camelia Maier
- Division of Biology, School of the Sciences, Texas Woman's University, Denton, TX, 76204-5799, USA.
| | - Dayna L Averitt
- Division of Biology, School of the Sciences, Texas Woman's University, Denton, TX, 76204-5799, USA.
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA.
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Li Y, Han X, Tong J, Wang Y, Liu X, Liao Z, Jiang M, Zhao H. Analysis of Metabolites in Gout: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:3143. [PMID: 37513561 PMCID: PMC10383779 DOI: 10.3390/nu15143143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Many studies have attempted to explore potential biomarkers for the early detection of gout, but consistent and high levels of evidence are lacking. In this study, metabolomics was used to summarize the changes of metabolites in the literature and explore the potential value of metabolites in predicting the occurrence and development of gout. (2) Methods: We searched the databases including the EMBASE, the Cochrane Library, PubMed, Web of Science, VIP Date, Wanfang Data, and CNKI, and the screening was fulfilled on 30 July 2022. The records were screened according to the inclusion criteria and the risk of bias was assessed. Qualitative analysis was performed for all metabolites, and meta-analysis was performed for metabolite concentrations using random effects to calculate the Std mean difference and 95% confidence interval. (3) Results: A total of 2738 records were identified, 33 studies with 3422 participants were included, and 701 metabolites were identified. The qualitative analysis results showed that compared with the healthy control group, the concentration of 56 metabolites increased, and 22 metabolites decreased. The results of the meta-analysis indicated that 17 metabolites were statistically significant. (4) Conclusions: Metabolites are associated with gout. Some specific metabolites such as uric acid, hypoxanthine, xanthine, KYNA, guanosine, adenosine, creatinine, LB4, and DL-2-Aminoadipic acid have been highlighted in the development of gout.
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Affiliation(s)
- Yuanyuan Li
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xu Han
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jinlin Tong
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuhe Wang
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xin Liu
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Zeqi Liao
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Miao Jiang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hongyan Zhao
- Medical Experimental Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Ayuso P, Macías Y, Gómez-Tabales J, García-Martín E, Agúndez JAG. Molecular monitoring of patient response to painkiller drugs. Expert Rev Mol Diagn 2022; 22:545-558. [PMID: 35733288 DOI: 10.1080/14737159.2022.2093638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Non-steroidal anti-inflammatory drugs and opioids are widely prescribed for the treatment of mild to severe pain. Wide interindividual variability regarding the analgesic efficacy and adverse reactions to these drugs (ADRs) exist, although the mechanisms responsible for these ADRs are not well understood. AREAS COVERED We provide an overview of the clinical impact of variants in genes related to the pharmacokinetics and pharmacodynamics of painkillers, as well as those associated with the susceptibility to ADRs. Also, we discuss the current pharmacogenetic-guided treatment recommendations for the therapeutic use of non-steroidal anti-inflammatory drugs and opioids. EXPERT OPINION In the light of the data analyzed, common variants in genes involved in pharmacokinetics and pharmacodynamics processes may partially explain the lack of response to painkiller treatment and the occurrence of adverse drug reactions. The implementation of high-throughput sequencing technologies may help to unveil the role of rare variants as considerable contributors to explaining the interindividual variability in drug response. Furthermore, a consensus between the diverse pharmacogenetic guidelines is necessary to extend the implementation of pharmacogenetic-guided prescription in daily clinical practice. Additionally, the physiologically-based pharmacokinetics and pharmacodynamics modeling techniques may contribute to the improvement of these guidelines and facilitate clinicians drug dose adjustment.
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Affiliation(s)
- Pedro Ayuso
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL, Instituto de Salud Carlos III, Cáceres, Spain
| | - Yolanda Macías
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL, Instituto de Salud Carlos III, Cáceres, Spain
| | - Javier Gómez-Tabales
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL, Instituto de Salud Carlos III, Cáceres, Spain
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL, Instituto de Salud Carlos III, Cáceres, Spain
| | - José A G Agúndez
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL, Instituto de Salud Carlos III, Cáceres, Spain
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Nguyen T, Muench U, Andraka-Christou B, Simon K, Bradford WD, Spetz J. The Association Between Scope of Practice Regulations and Nurse Practitioner Prescribing of Buprenorphine After the 2016 Opioid Bill. Med Care Res Rev 2022; 79:290-298. [PMID: 33792414 PMCID: PMC8594929 DOI: 10.1177/10775587211004311] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This article examines the relationship between federal regulations, state scope-of-practice regulations on nurse practitioners (NPs), and buprenorphine prescribing patterns using pharmacy claims data from Optum's deidentified Clinformatics Data Mart between January 2015 and September 2018. The county-level proportion of patients filling prescriptions written by NPs was low even after the 2016 Comprehensive Addiction and Recovery Act (CARA), 2.7% in states that did not require physician oversight of NPs, and 1.1% in states that did. While analyses in rural counties showed higher rates of buprenorphine prescriptions written by NPs, rates were still considerably low: 3.7% in states with less restrictive regulations and 1.1% in other states. These results indicate that less restrictive scope-of-practice regulations are associated with greater NP prescribing following CARA. The small magnitude of the changes indicates that federal attempts to expand treatment access through CARA have been limited.
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Affiliation(s)
| | | | | | - Kosali Simon
- Indiana University, Bloomington, IN, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | | | - Joanne Spetz
- University of California, San Francisco, CA, USA
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Moreno Ríos AL, Gutierrez-Suarez K, Carmona Z, Ramos CG, Silva Oliveira LF. Pharmaceuticals as emerging pollutants: Case naproxen an overview. CHEMOSPHERE 2022; 291:132822. [PMID: 34767851 DOI: 10.1016/j.chemosphere.2021.132822] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen (NP), diclofenac, ibuprofen, etc., are widely used for fever and pain relief. NP is one of the most widely consumed drugs in the world, because it is available over the counter in many countries. Many studies have proven that NP is not eliminated in conventional water treatment processes and its biodegradation in the environment is also difficult compared to other drugs. Along these lines, we are aware that both the original compound and its metabolites can be found in different destinations in the environment. To assess the environmental exposure and the risks associated with NP, it is important to understand better the environment where they finally reach, the behavior of its original compounds, its metabolites, and its transformation products. In this sense, the purpose of this review is to summarize the current state of knowledge about the introduction and behavior of NP in the environments they reach and highlight research needs and gaps. Likewise, we present the sources, environmental destinations, toxicology, environmental effects, and quantification methodologies.
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Affiliation(s)
- Andrea Liliana Moreno Ríos
- Department of Civil and Environmental, Universidad de la Costa, Barranquilla, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia.
| | - Karol Gutierrez-Suarez
- Department of Civil and Environmental, Universidad de la Costa, Barranquilla, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia
| | - Zenen Carmona
- Faculty of Medicine, Campus of Zaragocilla, University of Cartagena, Cartagena, Colombia
| | - Claudete Gindri Ramos
- Department of Civil and Environmental, Universidad de la Costa, Barranquilla, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia.
| | - Luis Felipe Silva Oliveira
- Department of Civil and Environmental, Universidad de la Costa, Barranquilla, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia
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Xuan Y, Zhang H, Liu D, Huang Y, Li L, Cao Q, Fu Y. The efficacy and safety of simple-needling for the treatment of primary dysmenorrhea compared with ibuprofen: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28919. [PMID: 35363216 PMCID: PMC9281921 DOI: 10.1097/md.0000000000028919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Needling and ibuprofen are often used clinically to treat primary dysmenorrhea (PD). However, the difference between the efficacy and safety of the treatment of PD is not clear. This study evaluates the efficacy and safety of simple-needling for PD patients through a comparison with ibuprofen. METHODS A comprehensive search of 7 electronic databases and relevant medical journals, from the establishment of the publication to December 2020. The Cochrane risk of bias tool was used to evaluate the methodological quality of randomized clinical trials (RCTs) that met the inclusion criteria, and a meta-analysis was performed with the Review Manager version (RevMan version 5.3). RESULTS Twenty three RCTs were included. The meta-analysis reported that simple-needling groups had better than ibuprofen groups on cure rate (relative risk = 2.29, 95% CI [1.96, 2.68], P < .00001) and total effective rate (relative risk = 1.24, 95% CI [1.19, 1.29], P < .00001) and VAS score (MD = -1.24, 95% CI [-1.92, -0.55], P = .0004). Seven studies reported adverse events, of which 4 studies had mild adverse events. CONCLUSION Simple-needling is superior to ibuprofen treatment in terms of clinical efficacy and improvement of pain symptoms. A small number of studies reported whether simple-needling produced adverse events, so there is not enough evidence to support the safety of simple-needling in the treatment of PD. PROSPERO REGISTRATION NUMBER CRD42021233403.
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Affiliation(s)
- Yichen Xuan
- Nanchang Medical College, Nanchang, China
- Science and Technology College of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Haifeng Zhang
- Department of Tuina, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Duanyong Liu
- Science and Technology College of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yiyong Huang
- Nanchang Medical College, Nanchang, China
- Science and Technology College of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Linhui Li
- Department of Acupuncture, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qianan Cao
- Graduate School of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yong Fu
- Department of Acupuncture, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Voute M, Riant T, Amodéo J, André G, Barmaki M, Collard O, Colomb C, Créac’h C, Deleens R, Delorme C, Montgazon G, Dixneuf V, Dy L, Gaillard J, Gov C, Kieffer X, Lanteri‐Minet M, Le Borgne J, Le Caër F, Maamar F, Maindet C, Marcaillou F, Plantevin F, Pluchon Y, Rioult B, Rostaing S, Salvat E, Sep Hieng V, Sorel M, Vergne‐Salle P, Morel V, Chazeron I, Pickering G. Ketamine in chronic pain: a Delphi survey. Eur J Pain 2022; 26:873-887. [DOI: 10.1002/ejp.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Marion Voute
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
| | - Thibault Riant
- Unité douleur, Le Confluent, Catherine de Sienne Center Nantes France
| | | | | | | | - Olivier Collard
- Centre d'Evaluation et de Traitement de la Douleur, Clinique Sainte Clotilde Ile de la Réunion France
| | | | - Christelle Créac’h
- Centre d'Evaluation et de Traitement de la Douleur, CHU Sainte Etienne Saint Etienne France
| | - Rodrigue Deleens
- Centre d'Evaluation et de Traitement de la Douleur, CHU Rouen France
| | - Claire Delorme
- Centre d'Evaluation et de Traitement de la Douleur, CH Bayeux Bayeux France
| | | | - Véronique Dixneuf
- Evaluation et de Traitement de la Douleur, Clinique Brétéché Nantes France
| | - Lénaïg Dy
- Evaluation et de Traitement de la Douleur, Clinique mutualiste de la porte de l’orient Lorient France
| | | | - Christian Gov
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital neurologique France
| | - Xavier Kieffer
- Centre de la Douleur Chronique et Rebelle, CH Versailles Le Chesnay France
| | - Michel Lanteri‐Minet
- Département d’Evaluation et Traitement de la Douleur Hopital de Cimiez Nice France
| | | | | | | | - Caroline Maindet
- Centre de la Douleur, Hôpital Albert Michallon La Tronche France
| | - Fabienne Marcaillou
- Centre d'Evaluation et de Traitement de la Douleur, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Plantevin
- Centre d'Evaluation et de Traitement de la Douleur, CH Mâcon Mâcon France
| | - Yves‐Marie Pluchon
- Centre d'Evaluation et de Traitement de la Douleur, CHD Vendée La Roche sur Yon France
| | - Bruno Rioult
- Unité douleur, Le Confluent, Catherine de Sienne Center Nantes France
| | | | - Eric Salvat
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital de Hautepierre Strasbourg France
| | | | - Marc Sorel
- Centre de la Douleur, CH Nemours Nemours France
| | | | - Véronique Morel
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
| | - Ingrid Chazeron
- Service de Psychiatrie B, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Gisèle Pickering
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
- Inserm, CIC 1405 UMR Neurodol 1407 Clermont‐Ferrand France
- Clermont Université, Laboratoire de Pharmacologie, Faculté de médecine Clermont‐Ferrand France
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Paglia DN, Kanjilal D, Kadkoy Y, Moskonas S, Wetterstrand C, Lin A, Galloway J, Tompson J, Culbertson MD, O’Connor JP. Naproxen treatment inhibits articular cartilage loss in a rat model of osteoarthritis. J Orthop Res 2021; 39:2252-2259. [PMID: 33274763 PMCID: PMC8175455 DOI: 10.1002/jor.24937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/27/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
The effects of naproxen, a nonsteroidal anti-inflammatory drug (NSAID), on articular cartilage degeneration in female Sprague-Dawley rats was examined. Osteoarthritis (OA) was induced by destabilization of the medial meniscus (DMM) in each knee. Rats were treated with acetaminophen (60 mg/kg), naproxen (8 mg/kg), or 1% carboxymethylcellulose (placebo) by oral gavage twice daily for 3 weeks, beginning 2 weeks after surgery. OA severity was assessed by histological Osteoarthritis Research Society International (OARSI) scoring and by measuring proximal tibia cartilage depth using contrast enhanced µCT (n = 6 per group) in specimens collected at 2, 5, and 7 weeks after surgery as well as on pristine knees. Medial cartilage OARSI scores from the DMM knees of naproxen-treated rats were statistically lower (i.e., better) than the medial cartilage OARSI scores from the DMM knees of placebo-treated rats at 5-weeks (8.7 ± 3.6 vs. 13.2 ± 2.4, p = 0.025) and 7-weeks (9.5 ± 1.2 vs. 12.5 ± 2.5, p = 0.024) after surgery. At 5 weeks after DMM surgery, medial articular cartilage depth in the proximal tibia specimens was significantly greater in the naproxen (1.78 ± 0.26 mm, p = 0.005) and acetaminophen (1.94 ± 0.12 mm, p < 0.001) treated rats as compared with placebo-treated rats (1.34 ± 0.24 mm). However, at 7 weeks (2 weeks after drug withdrawal), medial articular cartilage depth for acetaminophen-treated rats (1.36 ± 0.29 mm) was significantly reduced compared with specimens from the naproxen-treated rats (1.88 ± 0.14 mm; p = 0.004). The results indicate that naproxen treatment reduced articular cartilage degradation in the rat DMM model during and after naproxen treatment.
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Affiliation(s)
| | | | - Yazan Kadkoy
- Rutgers-New Jersey Medical School, Newark, NJ, USA
| | | | | | - Anthony Lin
- Rutgers-New Jersey Medical School, Newark, NJ, USA
| | | | | | | | - J. Patrick O’Connor
- Rutgers-New Jersey Medical School, Newark, NJ, USA
- School of Graduate Studies, Newark, NJ, USA
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10
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de Souza MM, Chagas LGRD, Gonçalves AE, Tomczak M, Reichert S, Schuquel ITA, Cechinel-Filho V, Meyre-Silva C. Phytochemical Analysis and Antinociceptive Properties of Hydroalcoholic Extracts of Aleurites moluccanus Bark. PLANTA MEDICA 2021; 87:896-906. [PMID: 34034350 DOI: 10.1055/a-1497-0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aleurites moluccanus is used in folk medicine to treat many diseases including pain and inflammatory processes in general. Considering the potential of the leaf extract, evidenced in a previous study, the present study investigates the antinociceptive and anti-inflammatory properties of the hydroethanolic extract of A. moluccanus bark and isolated compounds in animal models of pain. The antinociceptive and anti-inflammatory activities of A. moluccanus bark were evaluated through hyperalgesia induced by carrageenan, PGE2, cytokines, bradykinin, epinephrine, Freund's complete adjuvant, and lipopolysaccharide. Five compounds were isolated from the dichloromethane bark extract: acetyl aleuritolic acid, atraric acid, spruceanol, (5β,10α)-12-hydroxy-13-methoxy-8,11,13-podocarpatrien-3-one and sonderianol. To optimize the extraction conditions, ethanol 50, 70, and 90°GL were used as extracting solvent, in a 1 : 20 (w/v) drug : solvent ratio, under stirring at room temperature for 4 h. The extracts were named AMC50, AMC70, and AMC90, respectively. These extracts were administered to mice (250 mg/kg, p. o.) with reduced mechanical hyperalgesia activity in the carrageenan test. Of these, AMC90 showed the best results. Pure (5β,10α)-12-hydroxy-13-methoxy-8,11,13-podocarpatrien-3-one showed a beneficial effect for up to 48 hours after the administration of carrageenan, while acetyl aleuritolic acid was effective only in the first hour. AMC90 was able to reverse the analgesia induced only by prostaglandin E2 and tumor necrosis factor. We also induced hyperalgesia using the lipopolysaccharide and Freund's complete adjuvant models, with positive results. These results support the antinociceptive and anti-inflammatory activity of A. moluccanus bark extract. The observed effects are partly due to the presence of acetyl aleuritolic acid, atraric acid, and (5β,10α)-12-hydroxy-13-methoxy-8,11,13-podocarpatrien-3-one.
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Affiliation(s)
- Márcia Maria de Souza
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Luiz G R D Chagas
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Ana Elisa Gonçalves
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Marcelo Tomczak
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Simone Reichert
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Ivania T A Schuquel
- Universidade Estadual de Maringá (UEM), Departamento de Química, Maringá, Paraná State, Brazil
| | - Valdir Cechinel-Filho
- Universidade do Vale do Itajaí (UNIVALI), Escola de Ciências da Saúde, Itajaí, Santa Catarina State, Brazil
| | - Christiane Meyre-Silva
- Pós-graduação em Farmácia. Universidade Federal de Santa Catarina (UFSC), Bloco JK, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina State, Brazil
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Abstract
Gout is a disease in which the metabolic condition hyperuricemia leads to the formation of monosodium urate crystals, which provoke acute and chronic inflammatory responses through activation of the innate immune system. Recent advances in our knowledge of gout pathogenesis have emphasized the role of the kidneys in urate handling, the evolutionary loss of uricase as a necessary precondition for hyperuricemia, and the central role of IL-1ß in the pathogenesis of gouty inflammation. These, and other advances, have shaped our current strategies for managing gout. Here, we review the most current, evidence-based gout management approaches, including treating acute flares, addressing gout through the long-term regulation of serum urate, and prophylaxis against gouty flares during urate lowering.
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Affiliation(s)
- Michael H Pillinger
- The Division of Rheumatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States; The Section of Rheumatology, New York Harbor Health Care System, New York Campus of the U.S. Department of Veterans Affairs, New York, NY, United States.
| | - Brian F Mandell
- Rheumatic and Immunologic Diseases, The Cleveland Clinic, Cleveland, OH, United States
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Choi M, Wang L, Coroneos CJ, Voineskos SH, Paul J. Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs. CMAJ 2021; 193:E895-E905. [PMID: 34860688 PMCID: PMC8248454 DOI: 10.1503/cmaj.201915] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Analgesics that contain codeine are commonly prescribed for postoperative pain, but it is unclear how they compare with nonopioid alternatives. We sought to compare the effectiveness of codeine and nonsteroidal anti-inflammatory drugs (NSAIDs) for adults who underwent outpatient surgery. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials comparing codeine and NSAIDs for postoperative pain in outpatient surgery. We searched MEDLINE and Embase from inception to October 2019 for eligible studies. Our primary outcome was the patient pain score, converted to a standard 10-point intensity scale. Our secondary outcomes were patient-reported global assessments and adverse effects. We used random-effects models and grading of recommendations assessment, development and evaluation (GRADE) to assess the quality of evidence. RESULTS Forty studies, including 102 trial arms and 5116 patients, met inclusion criteria. The studies had low risk of bias and low-to-moderate heterogeneity. Compared with codeine, NSAIDs were associated with better pain scores at 6 hours (weighted mean difference [WMD] 0.93 points, 95% confidence interval [CI] 0.71 to 1.15) and at 12 hours (WMD 0.79, 95% CI 0.38 to 1.19). Stronger NSAID superiority at 6 hours was observed among trials where acetaminophen was coadministered at equivalent doses between groups (WMD 1.18, 95% CI 0.87 to 1.48). NSAIDs were associated with better global assessments at 6 hours (WMD -0.88, 95% CI -1.04 to -0.72) and at 24 hours (WMD -0.67, 95% CI -0.95 to -0.40), and were associated with fewer adverse effects, including bleeding events. INTERPRETATION We found that adult outpatients report better pain scores, better global assessments and fewer adverse effects when their postoperative pain is treated with NSAIDs than with codeine. Clinicians across all specialties can use this information to improve both pain management and opioid stewardship.
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Affiliation(s)
- Matthew Choi
- Departments of Surgery (Choi, Coroneos, Voineskos) and Anesthesia (Wang, Paul), McMaster University, Hamilton, Ont.
| | - Li Wang
- Departments of Surgery (Choi, Coroneos, Voineskos) and Anesthesia (Wang, Paul), McMaster University, Hamilton, Ont
| | - Christopher J Coroneos
- Departments of Surgery (Choi, Coroneos, Voineskos) and Anesthesia (Wang, Paul), McMaster University, Hamilton, Ont
| | - Sophocles H Voineskos
- Departments of Surgery (Choi, Coroneos, Voineskos) and Anesthesia (Wang, Paul), McMaster University, Hamilton, Ont
| | - James Paul
- Departments of Surgery (Choi, Coroneos, Voineskos) and Anesthesia (Wang, Paul), McMaster University, Hamilton, Ont
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13
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Brandl E, Halford Z, Clark MD, Herndon C. Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations. Ann Pharmacother 2021; 55:1486-1501. [PMID: 33771051 DOI: 10.1177/10600280211003875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder. DATA SOURCES A literature review was conducted using the search terms pain management, pharmacogenomics, pharmacogenetics, pharmacokinetics, pharmacodynamics, and opioids on PubMed (inception to February 1, 2021), CINAHL (2016 through February 1, 2021), and EMBASE (inception through February 1, 2021). STUDY SELECTION AND DATA EXTRACTION All relevant clinical trials, review articles, package inserts, and guidelines evaluating applicable pharmacogenotypes were considered for inclusion. DATA SYNTHESIS More than 300 Food and Drug Administration-approved medications contain pharmacogenomic information in their labeling. Genetic variability may alter the therapeutic effects of commonly prescribed pain medications. Pharmacogenomic-guided therapy continues to gain traction in clinical practice, but a multitude of barriers to widespread pharmacogenomic implementation exist. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Pain is notoriously difficult to treat given the need to balance safety and efficacy when selecting pharmacotherapy. Pharmacogenomic data can help optimize outcomes for patients with pain. With improved technological advances, more affordable testing, and a better understanding of genomic variants resulting in treatment disparities, pharmacogenomics continues to gain popularity. Unfortunately, despite these and other advancements, pharmacogenomic testing and implementation remain underutilized and misunderstood in clinical care, in part because of a lack of health care professionals trained in assessing and implementing test results. CONCLUSIONS A one-size-fits-all approach to pain management is inadequate and outdated. With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.
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Affiliation(s)
- Emily Brandl
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | | | - Matthew D Clark
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chris Herndon
- Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, USA.,St Louis University School of Medicine, MO, USA
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Miranda GM, Santos VORE, Bessa JR, Teles YCF, Yahouédéhou SCMA, Goncalves MS, Ribeiro-Filho J. Inclusion Complexes of Non-Steroidal Anti-Inflammatory Drugs with Cyclodextrins: A Systematic Review. Biomolecules 2021; 11:biom11030361. [PMID: 33673414 PMCID: PMC7996898 DOI: 10.3390/biom11030361] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 01/01/2023] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most widely used classes of medicines in the treatment of inflammation, fever, and pain. However, evidence has demonstrated that these drugs can induce significant toxicity. In the search for innovative strategies to overcome NSAID-related problems, the incorporation of drugs into cyclodextrins (CDs) has demonstrated promising results. This study aims to review the impact of cyclodextrin incorporation on the biopharmaceutical and pharmacological properties of non-steroidal anti-inflammatory drugs. A systematic search for papers published between 2010 and 2020 was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the following search terms: “Complexation”; AND “Cyclodextrin”; AND “non-steroidal anti-inflammatory drug”. A total of 24 different NSAIDs, 12 types of CDs, and 60 distinct inclusion complexes were identified, with meloxicam and β-CD appearing in most studies. The results of the present review suggest that CDs are drug delivery systems capable of improving the pharmacological and biopharmaceutical properties of non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- Gustavo Marinho Miranda
- Laboratory of Investigation in Genetics and Translational Hematology, Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, BA 40296-710, Brazil; (G.M.M.); (V.O.R.eS.); (S.C.M.A.Y.); (M.S.G.)
| | - Vitória Ohana Ramos e Santos
- Laboratory of Investigation in Genetics and Translational Hematology, Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, BA 40296-710, Brazil; (G.M.M.); (V.O.R.eS.); (S.C.M.A.Y.); (M.S.G.)
| | - Jonatas Reis Bessa
- Institute of Psychology (IPS), Federal University of Bahia (UFBA), Salvador, BA 40170-055, Brazil;
| | - Yanna C. F. Teles
- Agrarian Sciences Center (CCA), Department of Chemistry and Physics (DQF), Federal University of Paraiba (UFPB), Areia, PB 58397-000, Brazil;
| | - Setondji Cocou Modeste Alexandre Yahouédéhou
- Laboratory of Investigation in Genetics and Translational Hematology, Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, BA 40296-710, Brazil; (G.M.M.); (V.O.R.eS.); (S.C.M.A.Y.); (M.S.G.)
| | - Marilda Souza Goncalves
- Laboratory of Investigation in Genetics and Translational Hematology, Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, BA 40296-710, Brazil; (G.M.M.); (V.O.R.eS.); (S.C.M.A.Y.); (M.S.G.)
| | - Jaime Ribeiro-Filho
- Laboratory of Investigation in Genetics and Translational Hematology, Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, BA 40296-710, Brazil; (G.M.M.); (V.O.R.eS.); (S.C.M.A.Y.); (M.S.G.)
- Correspondence: ; Tel.: +55-71-3126-2226
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15
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Cagli A, Senol SP, Temiz-Resitoglu M, Guden DS, Sari AN, Sahan-Firat S, Tunctan B. Soluble epoxide hydrolase inhibitor trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl)urea prevents hyperalgesia through regulating NLRC4 inflammasome-related pro-inflammatory and anti-inflammatory signaling pathways in the lipopolysaccharide-induced pain mouse model. Drug Dev Res 2021; 82:815-825. [PMID: 33559150 DOI: 10.1002/ddr.21786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/22/2023]
Abstract
Epoxyeicosatrienoic acids (EETs) have anti-inflammatory effects and soluble epoxide hydrolase (sEH) inhibition might be a useful therapeutic approach to manage inflammatory disorders. The purpose of the study was to investigate whether nucleotide-binding and oligomerization domain-like receptor (NLR) C4 inflammasome-related pro-inflammatory and anti-inflammatory signaling pathways in the central nervous system (CNS) participates in the effect of trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl)urea (TPPU), a potent sEH inhibitor, to prevent hyperalgesia in the LPS-induced pain mouse model. The latency of pain within 30 s was measured by the hot plate test in male mice injected with saline, lipopolysaccharide (LPS) (10 mg/kg), and/or TPPU (0.3, 0.5, or 1 mg/kg) after 6 h. Hyperalgesia induced by LPS was associated with decreased 14,15-dihydroxyeicosatrienoic acid and interleukin (IL)-1β levels and enhanced expression of NLRC4, apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC), caspase-1 p20, IL-1β, and caspase-11 p20 in the brains and spinal cords of the animals. Besides the increased expression of nicotinamide adenine dinucleotide phosphate oxidase (NOX) subunits (gp91phox and p47phox ) and nitrotyrosine, a decrease in NLRC3, inducible nitric oxide synthase (iNOS), and neuronal NOS (nNOS) expression was also observed in the tissues of LPS-treated mice. TPPU at 0.5 mg/kg dose prevented the changes induced by LPS. Likely, decreased activity of pro-inflammatory NLRC4/ASC/pro-caspase-1 and caspase-11 inflammasomes and NOX in addition to enhanced levels of anti-inflammatory EETs and expression of NLRC3, iNOS, and nNOS in the CNS of mice participates in the protective effect of TPPU against LPS-induced hyperalgesia.
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Affiliation(s)
- Ali Cagli
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Sefika Pinar Senol
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | | | - Demet Sinem Guden
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Ayse Nihal Sari
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Seyhan Sahan-Firat
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Bahar Tunctan
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
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16
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Dawidowicz M, Kula A, Świętochowski P, Ostrowska Z. Assessment of the impact of PTGS1, PTGS2 and CYP2C9 polymorphisms on pain, effectiveness and safety of NSAID therapies. POSTEP HIG MED DOSW 2020. [DOI: 10.5604/01.3001.0014.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cyclooxygenase 1 and 2 (COX-1, COX-2) are enzymes that catalyze the first reaction in the arachidonic acid pathway. COXs are the therapeutic target for non-steroidal anti-inflammatory drugs. Inhibition of COX enzymatic activity has an analgesic, anti-inflammatory and sometimes antiplatelet effect. Single-nucleotide polymorphisms (SNPs) within genes encoding COX-1 and COX-2 (PTGS1, PTGS2) influence the risk of pain and their intensity in some diseases. They also affect the effectiveness of NSAID therapy in rheumatoid diseases. Moreover, the relationship between certain polymorphisms of PTGS2 and a higher risk of migraine and the development of aspirin resistance in the prophylaxis of cardiovascular diseases was demonstrated. The isoform of cytochrome P450, CYP2C9 has a significant influence on the efficacy and safety of NSAID use. It is responsible for the metabolism and speed of removal of these drugs. The occurrence of some of its polymorphic forms is associated with a decrease in CYP2C9 enzymatic activity, leading to changes in the pharmacokinetics and pharmacodynamics of NSAIDs. The prolonged half-life and decrease in clearance of these drugs lead to serious side effects such as hepatotoxicity, nephrotoxicity, anaphylactic reactions, cardiovascular or gastrointestinal incidents. Studies on polymorphisms of cyclooxygenases and CYP2C9 may improve the safety and efficacy of NSAIDs therapy by adjusting the dose to individual polymorphic variants, as well as expanding knowledge about the pathomechanism of inflammatory diseases.
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Affiliation(s)
- Miriam Dawidowicz
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
| | - Agnieszka Kula
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
| | | | - Zofia Ostrowska
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
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17
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The role of chronobiology in drug-resistance epilepsy: The potential use of a variability and chronotherapy-based individualized platform for improving the response to anti-seizure drugs. Seizure 2020; 80:201-211. [DOI: 10.1016/j.seizure.2020.06.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
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18
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Ilan Y. Overcoming Compensatory Mechanisms toward Chronic Drug Administration to Ensure Long-Term, Sustainable Beneficial Effects. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:335-344. [PMID: 32671136 PMCID: PMC7341037 DOI: 10.1016/j.omtm.2020.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic administration of drugs leads to the activation of compensatory mechanisms that may inhibit some of their activity and induce unwanted toxicity. These mechanisms are an obstacle for maintaining a sustainable effect for many chronic medications. Pathways that adapt to the burden induced by chronic drugs, whether or not related to the underlying disease, can lead to a partial or complete loss of effect. Variability characterizes many biological systems and manifests itself as large intra- and inter-individual differences in the response to drugs. Circadian rhythm-based chronotherapy is further associated with variability in responses noted among patients. This paper reviews current knowledge regarding the loss of effect of chronic medications and the range of variabilities that have been described in responses and loss of responses. Establishment of a personalized platform for overcoming these prohibitive mechanisms is presented as a model for ensuring long-term sustained medication effects. This novel platform implements personalized variability signatures and individualized circadian rhythms for preventing and opposing the prohibitive effect of the compensatory mechanisms induced by chronic drug administration.
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Affiliation(s)
- Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Ein-Kerem, IL91120 Jerusalem, Israel
- Corresponding author: Yaron Ilan, MD, Department of Medicine, Hebrew University-Hadassah Medical Center, Ein-Kerem, POB 1200, IL91120 Jerusalem, Israel
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19
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Hersh EV, Moore PA, Grosser T, Polomano RC, Farrar JT, Saraghi M, Juska SA, Mitchell CH, Theken KN. Nonsteroidal Anti-Inflammatory Drugs and Opioids in Postsurgical Dental Pain. J Dent Res 2020; 99:777-786. [PMID: 32286125 DOI: 10.1177/0022034520914254] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Postsurgical dental pain is mainly driven by inflammation, particularly through the generation of prostaglandins via the cyclooxygenase system. Thus, it is no surprise that numerous randomized placebo-controlled trials studying acute pain following the surgical extraction of impacted third molars have demonstrated the remarkable efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, etodolac, diclofenac, and ketorolac in this prototypic condition of acute inflammatory pain. Combining an optimal dose of an NSAID with an appropriate dose of acetaminophen appears to further enhance analgesic efficacy and potentially reduce the need for opioids. In addition to being on average inferior to NSAIDs as analgesics in postsurgical dental pain, opioids produce a higher incidence of side effects in dental outpatients, including dizziness, drowsiness, psychomotor impairment, nausea/vomiting, and constipation. Unused opioids are also subject to misuse and diversion, and they may cause addiction. Despite these risks, some dental surgical outpatients may benefit from a 1- or 2-d course of opioids added to their NSAID regimen. NSAID use may carry significant risks in certain patient populations, in which a short course of an acetaminophen/opioid combination may provide a more favorable benefit versus risk ratio than an NSAID regimen.
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Affiliation(s)
- E V Hersh
- Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - P A Moore
- Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - T Grosser
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R C Polomano
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J T Farrar
- Departments of Epidemiology/Biostatistics and Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Saraghi
- Department of Dentistry/Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York City, NY, USA
| | - S A Juska
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - C H Mitchell
- Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - K N Theken
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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20
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Abstract
BACKGROUND Little is known about how people respond to an analgesic adverse drug event despite the significant incidence of deaths and hospitalizations associated with analgesic adverse drug events. OBJECTIVE The purpose of this two-phase instrument development study was to test the validity and reliability of the Analgesic Adverse Drug Event Measure (AADEM). METHODS Content validity was established during Phase I. Six experts rated the 58-item measure developed from a pilot survey of adults who had experienced an analgesic adverse drug event. Experts' ratings supported a 17-item AADEM with a scale content validity index of .86. Phase II consisted of online administration of the AADEM to a national Qualtrics panel who reported an adverse drug event from a self-administered analgesic. Exploratory factor analysis was conducted using principal axis factoring and oblique rotation including Direct Oblimin and Promax rotations with Kaiser normalization. RESULTS Four factors emerged from the analysis: sought care, consulted provider, discontinued or continued analgesic, and attributed adverse drug event with a total explained variance of 55.4%. Scale content validity index for the 13-item AADEM was .88. Internal consistency for the four subscales was acceptable, but low for the full 13-item AADEM. DISCUSSION Results establish preliminary evidence for the validity and reliability of the 13-item AADEM to measure response to an analgesic adverse drug event. Next steps involve confirmatory factor analysis in a different sample to examine the underlying construct of the AADEM. The AADEM might help identify people at risk for serious analgesic adverse drug events.
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21
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Borro M, Guglielmetti M, Simmaco M, Martelletti P, Gentile G. The future of pharmacogenetics in the treatment of migraine. Pharmacogenomics 2019; 20:1159-1173. [PMID: 31637960 DOI: 10.2217/pgs-2019-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Migraine is considered one of the most disabling neurological disorder with a high socioeconomic burden. Pharmacological management includes many classes of drugs which in the most cases, are administrated in polytherapy. The therapeutic scheme of migraineurs is often affected by comorbidities which need concomitant medications, thus increasing the risk of side effects related to drug-drug interactions. Pharmacogenetics is a promising tool to achieve a personalized cure based on individual genetic profile while the availability of free online knowledge bases allows to check the potential DDIs of selected medications. Combining, these approaches may offer to clinicians a useful tool to improve the appropriateness of migraine polytherapy choice, aiming to increase the efficacy and reduce the toxicity of pharmacological treatments.
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Affiliation(s)
- Marina Borro
- Department of Neurosciences, Mental Health & Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy
| | - Martina Guglielmetti
- Department of Clinical & Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.,Department of Clinical Pathology, University of Sassari, Sassari, Italy
| | - Maurizio Simmaco
- Department of Neurosciences, Mental Health & Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical & Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Giovanna Gentile
- Department of Neurosciences, Mental Health & Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy
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