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Ramakrishnan P, Joshi A, Fazil M, Yadav P. A comprehensive review on therapeutic potentials of photobiomodulation for neurodegenerative disorders. Life Sci 2024; 336:122334. [PMID: 38061535 DOI: 10.1016/j.lfs.2023.122334] [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: 10/07/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
A series of experimental trials over the past two centuries has put forth Photobiomodulation (PBM) as a treatment modality that utilizes colored lights for various conditions. While in its cradle, PBM was used for treating simple conditions such as burns and wounds, advancements in recent years have extended the use of PBM for treating complex neurodegenerative diseases (NDDs). PBM has exhibited the potential to curb several symptoms and signs associated with NDDs. While several of the currently used therapeutics cause adverse side effects alongside being highly invasive, PBM on the contrary, seems to be broad-acting, less toxic, and non-invasive. Despite being projected as an ideal therapeutic for NDDs, PBM still isn't considered a mainstream treatment modality due to some of the challenges and knowledge gaps associated with it. Here, we review the advantages of PBM summarized above with an emphasis on the common mechanisms that underlie major NDDs and how PBM helps tackle them. We also discuss important questions such as whether PBM should be considered a mainstay treatment modality for these conditions and if PBM's properties can be harnessed to develop prophylactic therapies for high-risk individuals and also highlight important animal studies that underscore the importance of PBM and the challenges associated with it. Overall, this review is intended to bring the major advances made in the field to the spotlight alongside addressing the practicalities and caveats to develop PBM as a major therapeutic for NDDs.
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Affiliation(s)
- Pooja Ramakrishnan
- Fly Laboratory # 210, Anusandhan Kendra-II, School of Chemical & Biotechnology, SASTRA Deemed to be University, Thanjavur 613401, Tamil Nadu, India.
| | - Aradhana Joshi
- Fly Laboratory # 210, Anusandhan Kendra-II, School of Chemical & Biotechnology, SASTRA Deemed to be University, Thanjavur 613401, Tamil Nadu, India.
| | - Mohamed Fazil
- Fly Laboratory # 210, Anusandhan Kendra-II, School of Chemical & Biotechnology, SASTRA Deemed to be University, Thanjavur 613401, Tamil Nadu, India; School of Chemical & Biotechnology, SASTRA Deemed to be University, Thanjavur 613401, Tamil Nadu, India
| | - Pankaj Yadav
- Fly Laboratory # 210, Anusandhan Kendra-II, School of Chemical & Biotechnology, SASTRA Deemed to be University, Thanjavur 613401, Tamil Nadu, India.
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Barakat HE, Aziz CN, Abougalambou SSI. Evaluation of the knowledge, practices, and attitudes of community pharmacists towards adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a cross-sectional study. J Pharm Policy Pract 2023; 16:132. [PMID: 37915076 PMCID: PMC10621222 DOI: 10.1186/s40545-023-00641-1] [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: 07/26/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used over-the-counter medications for the treatment of pain, fever, and inflammation. Gastrointestinal problems and renal complications are the most frequently observed adverse effects associated with NSAID usage. Therefore, this study aims to evaluate the levels of knowledge, attitude, and practice regarding the adverse effects of non-prescription NSAIDs among community pharmacists in Egypt. METHODS A 4-month cross-sectional survey, including licenced community pharmacists in Egypt, was conducted. The anonymous Google Forms survey was accompanied by a cover letter explaining its purpose. The survey link was sent to 2000 verified community pharmacist email addresses with clear instructions to complete and submit the questionnaire within 3 weeks. Descriptive and inferential statistical analyses were conducted using IBM-SPSS version 26. The means of variables were compared using analysis of variance test. Pearson correlation was employed to assess the level of linear association between the overall knowledge, practice, and attitude scores. P-value ≤ 0.05 was considered statistically significant. RESULTS Approximately 80% of community pharmacists in Egypt exhibit moderate-to-good knowledge regarding the adverse effects of NSAIDs. Additionally, 60.6% of them demonstrated a positive attitude and 80.9% showed moderate-to-good practice scores towards preventing such adverse effects. The education level was the only demographic factor with significant effects on the NSAIDs-related knowledge, practice, and attitude scores. Community pharmacists primarily rely on internet sources for knowledge updates. Additionally, there was a significant positive linear correlation between knowledge and attitude (r = 0.384, P < 0.001), knowledge and practice (r = 0.178, P < 0.001), and between attitude and practice (r = 0.311, P < 0.001) among the participants. CONCLUSION Community pharmacists have a vital responsibility to perform screenings, assess patient risk elements, and share knowledge to guarantee the appropriate and safe utilisation of NSAIDs. Given that internet sources are presently the most accessible and used sources of information, governmental directions should prioritise the establishment and enhancement of freely accessible drug information sources for community pharmacists. Further research is necessary to assess the effectiveness of counselling and appropriate guidance provided by community pharmacies in promoting safe and proper drug usage.
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Affiliation(s)
- Hadeer Ehab Barakat
- Department of Clinical Pharmacy and Pharmacy Practice, Ahram Canadian University, Giza, Egypt.
| | - Christine Nazir Aziz
- Department of Clinical Pharmacy and Pharmacy Practice, Ahram Canadian University, Giza, Egypt
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Sha H, Yan B. Eu 3+ functionalized metal-organic framework for selective monitoring of emerging environmental pollutants non-steroidal anti-inflammatory drugs. Anal Chim Acta 2023; 1272:341525. [PMID: 37355323 DOI: 10.1016/j.aca.2023.341525] [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: 03/31/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs), as a new water pollutant emerging in recent years, has potential hazards to the environment. The difficult degradation characteristics of NSAIDs lead to long-term accumulation in the natural environment, which will inevitably cause incalculable damage to human health. In this work, for practical application considerations, MIL-53(Al) type MOF [Al(OH)(TDC)]‧1.5H2O‧0.7DMF (MIL-53-TDC, TDC = 2,5-thiophene dicarboxylic acid) with good water stability is selected as the sensing main body. The ligand TDC was chosen for two reasons: one is as an antenna ligand, which can sensitize Eu3+ ions to emit characteristic fluorescence; the other is as binding site that the sulfur atoms on the thiophene ring can introduce Eu3+ ions through coordination. Thus, Eu3+ functionalized MIL-53-TDC hybrid materials (Eu@MIL-53-TDC) were developed as a fluorescence sensor for the detection of two kinds of NSAIDs, S-ibuprofen (S-IBP) and diclofenac (DCF). The concentration range of S-IBP and DCF detected by the prepared sensors is 0.001-0.07 mM (LOD = 0.5 μM) and 0.0005-0.1 mM (LOD = 0.2 μM), respectively. Moreover, this sensor not only can achieve rapid (3 min) and sensitive analysis of these two NSAIDs but also has a satisfactory recovery for the detection of S-IBP and DCF in serum and tap water.
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Affiliation(s)
- Haifeng Sha
- School of Chemical Science and Engineering, Tongji University, Siping Road 1239, Shanghai, 200092, China
| | - Bing Yan
- School of Chemical Science and Engineering, Tongji University, Siping Road 1239, Shanghai, 200092, China.
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Çağlar EŞ, Okur ME, Aksu B, Üstündağ Okur N. Transdermal delivery of acemetacin loaded microemulsions: preparation, characterization, in vitro – ex vivo evaluation and in vivo analgesic and anti-inflammatory efficacy. J DISPER SCI TECHNOL 2023. [DOI: 10.1080/01932691.2023.2175691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Emre Şefik Çağlar
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Evren Okur
- Department of Pharmacology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Buket Aksu
- Department of Pharmaceutical Technology, School of Pharmacy, Altınbas University, Istanbul, Turkey
| | - Neslihan Üstündağ Okur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
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Peregrym K, Szczukowski Ł, Wiatrak B, Potyrak K, Czyżnikowska Ż, Świątek P. In Vitro and In Silico Evaluation of New 1,3,4-Oxadiazole Derivatives of Pyrrolo[3,4- d]pyridazinone as Promising Cyclooxygenase Inhibitors. Int J Mol Sci 2021; 22:ijms22179130. [PMID: 34502040 PMCID: PMC8431030 DOI: 10.3390/ijms22179130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 12/24/2022] Open
Abstract
Since long-term use of classic NSAIDs can cause severe side effects related mainly to the gastroduodenal tract, discovery of novel cyclooxygenase inhibitors with a safe gastric profile still remains a crucial challenge. Based on the most recent literature data and previous own studies, we decided to modify the structure of already reported 1,3,4-oxadiazole based derivatives of pyrrolo[3,4-d]pyridazinone in order to obtain effective COX inhibitors. Herein we present the synthesis, biological evaluation and molecular docking studies of 12 novel compounds with disubstituted arylpiperazine pharmacophore linked in a different way with 1,3,4-oxadiazole ring. None of the obtained molecules show cytotoxicity on NHDF and THP-1 cell lines and, therefore, all were qualified for further investigation. In vitro cyclooxygenase inhibition assay revealed almost equal activity of new derivatives towards both COX-1 and COX-2 isoenzymes. Moreover, all compounds inhibit COX-2 isoform better than Meloxicam which was used as reference. Anti-inflammatory activity was confirmed in biological assays according to which title molecules are able to reduce induced inflammation within cells. Molecular docking studies were performed to describe the binding mode of new structures to cyclooxygenase. Investigated derivatives take place in the active site of COX, very similar to Meloxicam. For some compounds, promising druglikeness was calculated using in silico predictions.
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Affiliation(s)
- Krzysztof Peregrym
- Department of Medicinal Chemistry, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
| | - Łukasz Szczukowski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
- Correspondence: (Ł.S.); (P.Ś.); Tel.: +48-71-784-03-91 (P.Ś.)
| | - Benita Wiatrak
- Department of Pharmacology, Faculty of Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (B.W.); (K.P.)
| | - Katarzyna Potyrak
- Department of Pharmacology, Faculty of Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (B.W.); (K.P.)
| | - Żaneta Czyżnikowska
- Department of Inorganic Chemistry, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
| | - Piotr Świątek
- Department of Medicinal Chemistry, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
- Correspondence: (Ł.S.); (P.Ś.); Tel.: +48-71-784-03-91 (P.Ś.)
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Kikuchi S, Togo K, Ebata N, Fujii K, Yonemoto N, Abraham L, Katsuno T. A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain. PAIN MEDICINE 2021; 22:1029-1038. [PMID: 33585939 DOI: 10.1093/pm/pnaa421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT The real-world burden of gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in Japanese patients with osteoarthritis (OA) and/or chronic low back pain (CLBP) remains unreported. OBJECTIVE To assess the incidence and economic burden of NSAID-induced GI events by using data from large-scale real-world databases. METHODS We used the Japanese Medical Data Center database to retrospectively evaluate anonymized claims data of medical insurance beneficiaries employed by middle- to large-size Japanese companies who were prescribed NSAIDs for OA and/or CLBP between 2009 and 2018. RESULTS Overall, 180,371 patients were included in the analysis, of whom 32.9% had OA, 53.8% had CLBP, and 13.4% had both OA and CLBP. NSAIDs were administered as first-line analgesics to 161,152 (89.3%) of the patients in the sample, in oral form to 90.3% and as topical patches to 80.4%. A total of 65.1% used combined oral/topical patches. Of the 21.0% of patients consistently using NSAIDs (percentage of days supplied ≥70%), 54.5% received patches. A total of 51.5% patients used NSAIDs for >1 to ≤6 months. The incidence of GI events was 9.97 per 10,000 person-years (95% confidence interval: 8.92-11.03). The risk of developing GI events was high in elderly patients and patients with comorbidities and remained similar for patients receiving oral vs. topical NSAIDs. Longer treatment duration and consistent NSAID use increased the risk of GI events. The cost (median [interquartile range]) of medications (n = 327) was US$ 80.70 ($14.10, $201.40), that of hospitalization (n = 33) was US$ 2,035.50 ($1,517.80, $2,431.90), and that of endoscopic surgery (n = 52) was US$ 418.20 ($418.20, $418.20). CONCLUSION NSAID-associated GI toxicity imposes a significant health and economic burden on patients with OA and/or CLBP, irrespective of whether oral or topical NSAIDs are used.
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Affiliation(s)
- Shogo Kikuchi
- Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan
| | | | | | | | | | | | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Aichi, Japan
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Santos-Moreno P, Alvis-Zakzuk NJ, Villarreal-Peralta L, Carrasquilla-Sotomayor M, de la Hoz-Restrepo F, Alvis-Guzmán N. Centers of Excellence Implementation for Treating Rheumatoid Arthritis in Colombia: A Cost-Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:583-591. [PMID: 34188503 PMCID: PMC8236254 DOI: 10.2147/ceor.s308024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Health systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia. Methods A cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel®, and R. Results Expenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978-1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710-708,476), which implies potential cost-savings of up to US$223,874 per year. Conclusion The strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs.
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Affiliation(s)
| | | | | | | | | | - Nelson Alvis-Guzmán
- Department of Health Sciences, Universidad de la Costa - CUC, Barranquilla, Colombia.,Department of Economic Sciences, Universidad de Cartagena, Cartagena, Colombia
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Bou-Salah L, Benarous K, Linani A, Rabhi F, Chaib K, Chine I, Bensaidane H, Yousfi M. Anti-inflammatory drugs as new inhibitors to xanthine oxidase: In vitro and in silico approach. Mol Cell Probes 2021; 58:101733. [PMID: 33957269 DOI: 10.1016/j.mcp.2021.101733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/06/2023]
Abstract
The two important targets to treat gout disease are (1) control the hyperuricemia by the inhibition of Xanthine Oxidase (XO) and (2) treatment of acute attacks of gout by the use of anti-inflammatory drugs. It is important to distinguish between therapy to manage hyperuricemia and to reduce acute inflammation. While reducing hyperuricemia is resolved very slowly with available drugs, gout symptoms like pain and inflammation may become persistent. The objective of this study is to find a relevant treatment with a beneficial double effect. (1) As an anti-inflammatory, analgesic, and antipyretic effect and (2) as XO inhibitory effect, which is the main objective of this study. We investigated the effect of five non-steroidal anti-inflammatory drugs (NSAIDs) against human and bovine milk xanthine oxidases (HXO and BXO) using the double enzyme detection method (DED) and molecular docking with the Autodock vina program. in vitro results show that the NSAIDs give an important inhibition to HXO and BXO with an IC50 of 2.04 ± 0.13 μg/ml, 2.75 ± 0.23 μg/ml, 1.45 ± 0.19 μg/ml, 0.31 ± 0.13 μg/ml and 1.27 ± 0.11 μg/ml, for HXO, and 2.96 ± 0.27 μg/ml, 9.46 ± 0.13 μg/ml, 6.21 ± 1.17 μg/ml, 0.83 ± 0.11 μg/ml, and 3.48 ± 0.13 μg/ml, for BXO, for respectively, Naproxen, Ibuprofen, Diclofenac, Indomethacin, and Celecoxib. Testing the inhibitory activity of these drugs on both XOs shows an important inhibition, especially from Indomethacin, which could be a promising lead compound for reducing acute inflammation and at the same time controlling hyperuricemia.
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Affiliation(s)
- Leila Bou-Salah
- Laboratory of Fundamental Sciences, University of Amar Telidji, Laghouat, Algeria.
| | - Khedidja Benarous
- Laboratory of Fundamental Sciences, University of Amar Telidji, Laghouat, Algeria; Biology Department, University of Amar Telidji, Laghouat, Algeria
| | - Abderahmane Linani
- Laboratory of Fundamental Sciences, University of Amar Telidji, Laghouat, Algeria
| | - Faiza Rabhi
- Biology Department, University of Amar Telidji, Laghouat, Algeria
| | - Kheira Chaib
- Biology Department, University of Amar Telidji, Laghouat, Algeria
| | - Imane Chine
- Biology Department, University of Amar Telidji, Laghouat, Algeria
| | | | - Mohamed Yousfi
- Laboratory of Fundamental Sciences, University of Amar Telidji, Laghouat, Algeria
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Patel J, Ladani A, Sambamoorthi N, LeMasters T, Dwibedi N, Sambamoorthi U. A Machine Learning Approach to Identify Predictors of Potentially Inappropriate Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Use in Older Adults with Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010155. [PMID: 33379288 PMCID: PMC7794853 DOI: 10.3390/ijerph18010155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Evidence from some studies suggest that osteoarthritis (OA) patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) that are not in accordance with their cardiovascular (CV) or gastrointestinal (GI) risk profiles. However, no such study has been carried out in the United States. Therefore, we sought to examine the prevalence and predictors of potentially inappropriate NSAIDs use in older adults (age > 65) with OA using machine learning with real-world data from Optum De-identified Clinformatics® Data Mart. We identified a retrospective cohort of eligible individuals using data from 2015 (baseline) and 2016 (follow-up). Potentially inappropriate NSAIDs use was identified using the type (COX-2 selective vs. non-selective) and length of NSAIDs use and an individual's CV and GI risk. Predictors of potentially inappropriate NSAIDs use were identified using eXtreme Gradient Boosting. Our study cohort comprised of 44,990 individuals (mean age 75.9 years). We found that 12.8% individuals had potentially inappropriate NSAIDs use, but the rate was disproportionately higher (44.5%) in individuals at low CV/high GI risk. Longer duration of NSAIDs use during baseline (AOR 1.02; 95% CI:1.02-1.02 for both non-selective and selective NSAIDs) was associated with a higher risk of potentially inappropriate NSAIDs use. Additionally, individuals with low CV/high GI (AOR 1.34; 95% CI:1.20-1.50) and high CV/low GI risk (AOR 1.61; 95% CI:1.34-1.93) were also more likely to have potentially inappropriate NSAIDs use. Heightened surveillance of older adults with OA requiring NSAIDs is warranted.
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Affiliation(s)
- Jayeshkumar Patel
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
- Correspondence:
| | - Amit Ladani
- Rheumatology, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Nethra Sambamoorthi
- Masters in Data Science Program, School of Professional Studies, Northwestern University, Chicago, IL 60201, USA;
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
- Department of Pharmacotherapy, HSC College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA
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Design, Synthesis and Comprehensive Investigations of Pyrrolo[3,4- d]pyridazinone-Based 1,3,4-Oxadiazole as New Class of Selective COX-2 Inhibitors. Int J Mol Sci 2020; 21:ijms21249623. [PMID: 33348757 PMCID: PMC7766220 DOI: 10.3390/ijms21249623] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
The long-term use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in treatment of different chronic inflammatory disorders is strongly restricted by their serious gastrointestinal adverse effects. Therefore, there is still an urgent need to search for new, safe, and efficient anti-inflammatory agents. Previously, we have reported the Mannich base-type derivatives of pyrrolo[3,4-d]pyridazinone which strongly inhibit cyclooxygenase, have better affinity to COX-2 isoenzyme and exert promising anti-oxidant activity. These findings encouraged us to perform further optimization of that structure. Herein, we present the design, synthesis, molecular docking, spectroscopic, and biological studies of novel pyrrolo[3,4-d]pyridazinone derivatives bearing 4-aryl-1-(1-oxoethyl)piperazine pharmacophore 5a,b–6a,b. The new compounds were obtained via convenient, efficient, one-pot synthesis. According to in vitro evaluations, novel molecules exert no cytotoxicity and act as selective COX-2 inhibitors. These findings stay in good correlation with molecular modeling results, which additionally showed that investigated compounds take a position in the active site of COX-2 very similar to Meloxicam. Moreover, all derivatives reduce the increased level of reactive oxygen and nitrogen species and prevent DNA strand breaks caused by oxidative stress. Finally, performed spectroscopic and molecular docking studies demonstrated that new compound interactions with bovine serum albumin (BSA) are moderate, formation of complexes is in one-to-one ratio, and binding site II (subdomain IIIA) is favorable.
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Lima SNP, Cerdeira CD, Santos GB, Fernandes MDM, Giusti-Paiva A, Brigagão MRPL. Tempol modulates the leukocyte response to inflammatory stimuli and attenuates endotoxin-induced sickness behaviour in mice. Arch Physiol Biochem 2020; 126:341-347. [PMID: 30465447 DOI: 10.1080/13813455.2018.1538247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and aims: Lipopolysaccharide (LPS), an endotoxin, is a component of the outer membrane of Gram-negative bacteria that is able to activate the peripheral immune system, leading to changes in signalling pathways that act locally and systemically to achieve adaptive responses. Sickness behaviour is a motivational state in response to endotoxin exposure and includes depressed activity and a reduction of exploratory behaviour, potentially reorganising organism priorities to cope with infectious diseases. We hypothesised that 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol) modulates the leukocyte response to endotoxins and decreases LPS-induced sickness behaviour in mice.Methods: The effects of Tempol on LPS-induced peritonitis and the respiratory burst of neutrophils primed with LPS and triggered by phorbol 12-myristate-13-acetate (PMA) were evaluated. To evaluate the effects of Tempol on sickness behaviour, the mice were submitted to an open field and forced swim tests.Results: Tempol (50-100 μM/106 cells) decreased the respiratory burst of LPS-primed and PMA-stimulated neutrophils in vitro. In vivo, this nitroxide (30 and 100 mg/kg body weight) inhibited leukocyte migration to the peritoneal cavity after LPS administration in mice. Moreover, Tempol pretreatment (30 and 100 mg/kg body weight) before LPS administration also attenuated sickness behavioural changes.Conclusions: Together, these findings shed light on the mechanisms underlying the anti-inflammatory potential and confirm the therapeutic potential of nitroxides.
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Affiliation(s)
- Samuel Nuno Pereira Lima
- Department of Biochemistry (DBq), Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Cláudio Daniel Cerdeira
- Department of Biochemistry (DBq), Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Gérsika Bitencourt Santos
- Department of Biochemistry (DBq), Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Mateus de Mello Fernandes
- Department of Biochemistry (DBq), Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Alexandre Giusti-Paiva
- Department of Physiology, Institute of Biomedical Sciences; Federal University of Alfenas, Alfenas, Brazil
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Spitaels D, Vankrunkelsven P, Desfosses J, Luyten F, Verschueren S, Van Assche D, Aertgeerts B, Hermens R. Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective. J Eval Clin Pract 2017; 23:165-172. [PMID: 27859970 DOI: 10.1111/jep.12660] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated. METHODS Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software. RESULTS In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers. CONCLUSIONS Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.
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Affiliation(s)
- David Spitaels
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | | | - Frank Luyten
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Dieter Van Assche
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Bert Aertgeerts
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.,IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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13
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Gunter BR, Butler KA, Wallace RL, Smith SM, Harirforoosh S. Non-steroidal anti-inflammatory drug-induced cardiovascular adverse events: a meta-analysis. J Clin Pharm Ther 2016; 42:27-38. [DOI: 10.1111/jcpt.12484] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 10/26/2016] [Indexed: 01/07/2023]
Affiliation(s)
- B. R. Gunter
- Gatton College of Pharmacy; East Tennessee State University; Johnson City TN USA
| | - K. A. Butler
- Gatton College of Pharmacy; East Tennessee State University; Johnson City TN USA
| | - R. L. Wallace
- Quillen College of Medicine Library; East Tennessee State University; Johnson City TN USA
| | - S. M. Smith
- Division of Cardiology; Department of Internal Medicine; Quillen College of Medicine; East Tennessee State University; Johnson City TN USA
| | - S. Harirforoosh
- Department of Pharmaceutical Sciences; Gatton College of Pharmacy; East Tennessee State University; Johnson City TN USA
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Discovery of substituted-2,4-dimethyl-(naphthalene-4-carbonyl)amino-benzoic acid as potent and selective EP4 antagonists. Bioorg Med Chem Lett 2015; 26:105-9. [PMID: 26608552 DOI: 10.1016/j.bmcl.2015.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 02/06/2023]
Abstract
A novel series of EP4 antagonists, based on a quinoline scaffold, has been discovered. Medicinal chemistry efforts to optimize the potency of the initial hit are described. A highly potent compound in a clinically relevant human whole blood assay was identified. Selectivity and pharmacokinetic profiles of this compound are discussed.
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15
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Mohammadi R, Amini K, Abdollahi-Pirbazari M, Yousefi A. Acetyl salicylic acid locally enhances functional recovery after sciatic nerve transection in rat. Neurol Med Chir (Tokyo) 2013; 53:839-46. [PMID: 24140781 PMCID: PMC4508728 DOI: 10.2176/nmc.oa2012-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Local effect of acetyl salicylic acid (ASA) on peripheral nerve regeneration was studied using a rat sciatic nerve transection model. Forty-five male healthy White Wistar rats were divided into three experimental groups (n = 15), randomly: Sham-operation (SHAM), control (SIL), and ASA-treated (SIL/ASA) groups. In SHAM group after anesthesia left sciatic nerve was exposed through a gluteal muscle incision and after homeostasis the muscle was sutured. In SIL group the left sciatic nerve was exposed the same way and transected proximal to tibio-peroneal bifurcation leaving a 10-mm gap. Proximal and distal stumps were each inserted into a silicone tube and filled with 10 μl phosphate buffered solution. In SIL/ASA group defect was bridged using a silicone tube filled with 10 μl acetyl salisylic acid (0.1 mg/ml). Each group was subdivided into three subgroups of five animals each and were studied 4, 8, and 12 weeks after surgery. Data were analyzed statistically by factorial analysis of variance (ANOVA) and the Bonferroni test for pair-wise comparisons. Functional study confirmed faster and better recovery of regenerated axons in SIL/ASA than in SIL group (p < 0.05). Gastrocnemius muscle mass in SIL/ASA was significantly more than in SIL group. Morphometric indices of regenerated fibers showed that the number and diameter of the myelinated fibers in SIL/ASA were significantly higher than in control group. In immuohistochemistry, location of reactions to S-100 in SIL/ASA was clearly more positive than in SIL group. Response to local treatment of ASA demonstrates that it influences and improves functional recovery of peripheral nerve regeneration.
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Affiliation(s)
- Rahim Mohammadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University
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Mohammadi R, Mehrtash M, Nikonam N, Mehrtash M, Amini K. Ketoprofen combined with artery graft entubulization improves functional recovery of transected peripheral nerves. J Craniomaxillofac Surg 2013; 42:2076-81. [PMID: 23932540 DOI: 10.1016/j.jcms.2013.05.026] [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: 02/06/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022] Open
Abstract
The objective was to assess the local effect of ketoprofen on sciatic nerve regeneration and functional recovery. Eighty healthy male white Wistar rats were randomized into four experimental groups of 20 animals each: In the transected group (TC), the left sciatic nerve was transected and nerve cut ends were fixed in the adjacent muscle. In the treatment group the defect was bridged using an artery graft (AG/Keto) filled with 10 microliter ketoprofen (0.1 mg/kg). In the artery graft group (AG), the graft was filled with phosphated-buffer saline alone. In the sham-operated group (SHAM), the sciatic nerve was exposed and manipulated. Each group was subdivided into four subgroups of five animals each and regenerated nerve fibres were studied at 4, 8, 12 and 16 weeks post operation. Behavioural testing, sciatic nerve functional study, gastrocnemius muscle mass and morphometric indices showed earlier regeneration of axons in AG/Keto than in AG group (p < 0.05). Immunohistochemical study clearly showed more positive location of reactions to S-100 in AG/Keto than in AG group. When loaded in an artery graft, ketoprofen improved functional recovery and morphometric indices of the sciatic nerve. Local usage of this easily accessible therapeutic medicine is cost saving and avoids the problems associated with systemic administration.
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Affiliation(s)
- Rahim Mohammadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University, Nazloo Road, Urmia 57153 1177, Iran; Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran.
| | - Moein Mehrtash
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University, Nazloo Road, Urmia 57153 1177, Iran
| | - Nima Nikonam
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran
| | - Moied Mehrtash
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran
| | - Keyvan Amini
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4, Canada
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17
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Mohammadi R, Hirsaee MA, Amini K. Improvement of functional recovery of transected peripheral nerve by means of artery grafts filled with diclofenac. Int J Surg 2013; 11:259-64. [DOI: 10.1016/j.ijsu.2013.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/09/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
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18
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Analisi di costo della terapia con celecoxib vs FANS tradizionali nell’artrosi in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Viljoen A, Mncwangi N, Vermaak I. Anti-inflammatory iridoids of botanical origin. Curr Med Chem 2012; 19:2104-27. [PMID: 22414102 PMCID: PMC3873812 DOI: 10.2174/092986712800229005] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/07/2012] [Accepted: 01/08/2012] [Indexed: 11/22/2022]
Abstract
Inflammation is a manifestation of a wide range of disorders which include; arthritis, atherosclerosis, Alzheimer's disease, inflammatory bowel syndrome, physical injury and infection amongst many others. Common treatment modalities are usually nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, paracetamol, indomethacin and ibuprofen as well as corticosteroids such as prednisone. These however, may be associated with a host of side effects due to non-selectivity for cyclooxygenase (COX) enzymes involved in inflammation and those with selectivity may be highly priced. Thus, there is a continuing search for safe and effective antiinflammatory molecules from natural sources. Research has confirmed that iridoids exhibit promising anti-inflammatory activity which may be beneficial in the treatment of inflammation. Iridoids are secondary metabolites present in various plants, especially in species belonging to the Apocynaceae, Lamiaceae, Loganiaceae, Rubiaceae, Scrophulariaceae and Verbenaceae families. Many of these ethnobotanicals have an illustrious history of traditional use alluding to their use to treat inflammation. Although iridoids exhibit a wide range of pharmacological activities such as cardiovascular, hepatoprotection, hypoglycaemic, antimutagenic, antispasmodic, anti-tumour, antiviral, immunomodulation and purgative effects this review will acutely focus on their anti-inflammatory properties. The paper aims to present a summary for the most prominent iridoid-containing plants for which anti-inflammatory activity has been demonstrated in vitro and / or in vivo.
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Affiliation(s)
- A Viljoen
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Pretoria, South Africa.
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20
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Mizokami Y. Efficacy and safety of rabeprazole in non-steroidal anti-inflammatory drug-induced ulcer in Japan. World J Gastroenterol 2009; 15:5097-102. [PMID: 19860005 PMCID: PMC2768891 DOI: 10.3748/wjg.15.5097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and safety of rabeprazole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan.
METHODS: Subjects comprised patients undergoing NSAID treatment in whom upper gastrointestinal endoscopy revealed an ulcerous lesion (open ulcer) with diameter ≥ 3 mm, who required continuous NSAID treatment. Endoscopies were performed at the start of treatment, during the treatment period, and at the conclusion (or discontinuation) of treatment. Findings were evaluated as size (maximum diameter) and stage based on the Sakita-Miwa classification. An ulcer was regarded as cured when the “white coating” was seen to have disappeared under endoscopy. As criteria for evaluating safety, all medically untoward symptoms and signs (adverse events, laboratory abnormalities, accidental symptoms, etc.) occurring after the start of rabeprazole treatment were handled as adverse events.
RESULTS: Endoscopic cure rate in 38 patients in the efficacy analysis (endoscopic evaluation) was 71.1% (27/38). Among those 38 patients, 35 had gastric ulcer with a cure rate of 71.4% (25/35), and 3 had duodenal ulcer with a cure rate of 66.7% (2/3). Three adverse drug reactions were reported from 64 patients in the safety analysis (interstitial pneumonia, low white blood cell count and pruritus); thus, the incidence rate for adverse drug reactions was 4.7% (3/64).
CONCLUSION: The treatment efficacy of rabeprazole for NSAID-induced ulcer under continuous NSAID administration was confirmed.
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21
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Harirforoosh S, Jamali F. Renal adverse effects of nonsteroidal anti-inflammatory drugs. Expert Opin Drug Saf 2009; 8:669-81. [DOI: 10.1517/14740330903311023] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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22
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Abstract
NSAIDs incur significant gastrointestinal (GI) side effects. The complication risk increases with history of peptic ulcer or older age. Helicobacter pylori infection and cardioprotective aspirin have independent and additive risks in the presence of NSAID use. NSAID enteropathy is increasingly recognized. Cardiovascular and GI risk stratification and H. pylori infection testing should be done before initiating NSAIDs. An NSAID combined with a proton pump inhibitor (PPI) is comparable to cyclooxygenase (COX)-2 inhibitors for gastroprotection, but for high-risk patients, COX-2 plus PPI should be considered. Aspirin and COX-2 inhibitors are associated with reduced colon adenoma risk, but higher dose and longer duration of treatment with aspirin appears effective. Hence, patients at high risk of colorectal cancer (with significant family or personal history of premalignant adenoma) must be identified, and cardiovascular and GI risk must be assessed before using these agents as chemopreventive drugs.
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Affiliation(s)
- Maneesh Gupta
- Division of Gastroenterology, Digestive Health Center, Center for Health and Healing, 6th Floor, Oregon Health and Science University, Portland, OR 97239, USA
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23
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Chan FKL, Abraham NS, Scheiman JM, Laine L. Management of patients on nonsteroidal anti-inflammatory drugs: a clinical practice recommendation from the First International Working Party on Gastrointestinal and Cardiovascular Effects of Nonsteroidal Anti-inflammatory Drugs and Anti-platelet Agents. Am J Gastroenterol 2008; 103:2908-18. [PMID: 18853980 DOI: 10.1111/j.1572-0241.2008.02200.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prescribing nonsteroidal antiinflammatory drugs (NSAIDs) is challenging because physicians have to consider gastrointestinal (GI) and cardiovascular (CV) safety issues. OBJECTIVE The purpose of the study was to determine appropriate NSAID treatment strategies based on different combinations of GI and CV risks. METHODS The working party comprised a multidisciplinary international panel of 19 experts. Two hundred eighty-eight vignettes were evaluated for the appropriateness of each of six options: naproxen, non-naproxen nonselective NSAIDs, naproxen plus proton pump inhibitor (PPI)/misoprostol, non-naproxen nonselective NSAID plus PPI/misoprostol, cyclooxygenase-2 selective NSAID (coxib), or coxib plus PPI/misoprostol. Using a two-stage modified Delphi process, the panel anonymously ranked the appropriateness of each option from 1 (extremely inappropriate) to 9 (extremely appropriate). Vignettes were considered appropriate if > or = 80% of all panelists' scores were 7-9 and inappropriate if > or = 80% of all panelists' scores were 1-3. RESULTS The panel rated nonselective NSAIDs as appropriate when the patient had average GI risk (< 70 yr of age; no prior upper GI event; no corticosteroids, antithrombotic agents, anticoagulants). In patients with GI risk factors, cotherapy with a PPI/misoprostol was appropriate. Either a nonselective NSAID or a coxib was rated appropriate in patients with average CV risk; naproxen was preferred in patients with high CV risk. None of the options was considered appropriate in patients with multiple GI risk factors and high CV risk. CONCLUSIONS The initial choice of an NSAID (naproxen vs. others) relates to a patient's CV risk, and the need for therapy to decrease GI complications (PPI/misoprostol or coxibs) is determined by severity and number of GI risk factors.
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Affiliation(s)
- Francis K L Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong
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24
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Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R. Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008; 16:415-22. [PMID: 18296075 DOI: 10.1016/j.joca.2007.12.017] [Citation(s) in RCA: 335] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 12/26/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the pain experience of people with hip or knee osteoarthritis (OA), particularly changes over time and most distressing features. METHOD Focus groups in individuals aged 40+ years with painful hip or knee OA obtained detailed descriptions of OA pain from early to late disease. A modified Patient Generated Index (PGI) was used to assess the features of OA pain that participants found most distressing. Content analysis was performed to examine response patterns; descriptive statistics were used to summarize PGI responses. RESULTS Mean age of the 143 participants (52 hip OA; 91 knee OA) was 69.5 years (47-92 years); 60.8% were female and 93.7% Caucasian. Participants described two distinct types of pain - a dull, aching pain, which became more constant over time, punctuated increasingly with short episodes of a more intense, often unpredictable, emotionally draining pain. The latter, but not the former, resulted in significant avoidance of social and recreational activities. From PGI responses, distressing pain features were: the pain itself (particularly intense and unpredictable pain) and the pain's impact on mobility, mood and sleep. CONCLUSIONS Two distinct pain types were identified. Intermittent intense pain, particularly when unpredictable, had the greatest impact on quality of life.
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Affiliation(s)
- G A Hawker
- Division of Rheumatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
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Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med 2007; 49:670-7. [PMID: 17276548 PMCID: PMC7115288 DOI: 10.1016/j.annemergmed.2006.11.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 09/12/2006] [Accepted: 11/15/2006] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE We compare the analgesic efficacy and adverse effects of oral prednisolone/acetaminophen and oral indomethacin/acetaminophen combination therapy in the treatment of acute goutlike arthritis in patients presenting to an emergency department (ED). METHODS This is a double-blind, randomized, controlled study in a university hospital emergency department (ED) in the New Territories of Hong Kong. Patients older than 17 years and presenting between February 1, 2003, and June 30, 2004, with a clinical diagnosis of goutlike arthritis were randomized to receive either oral prednisolone/acetaminophen or oral indomethacin/acetaminophen combination therapy. Primary outcome measures were pain scores, time to resolution of symptoms and signs, and adverse effects. Secondary outcome measures were the need for additional acetaminophen and relapse rate. RESULTS There were 90 patients randomized: 46 patients to the indomethacin group and 44 patients to the prednisolone group. Baseline characteristics, including pain scores, were similar in the 2 groups. Both treatment groups had a similar decrease in pain score in the ED. The mean rate of decrease in pain score with activity for indomethacin was -1.7+/-1.6 (SD) mm per day and for prednisolone was -2.9+/-2.0 (SD) mm per day (mean difference 1.2 mm/day; 95% confidence interval 0.4 to 2.0 mm/day; P=.0026). Although these differences were statistically significant, at no time was the difference in mean pain score greater than 13 mm. Therefore, it is unclear whether these differences are clinically significant. The mean total dose of acetaminophen consumed by the prednisolone group was significantly more than in the indomethacin group (mean 10.3 g, range 1 to 21 g versus mean 6.4 g, range 1 to 21 g). Twenty-nine patients in the indomethacin group and 12 patients in the prednisolone group experienced adverse effects (P<.05). The commonest adverse effects in the indomethacin group were nausea, indigestion, epigastric pain, dizziness, and gastrointestinal bleeding (N=5; 11%). None of the patients in the prednisolone group developed gastrointestinal bleeding. The relapse rate for both groups was similar. CONCLUSION In the treatment of acute goutlike arthritis, oral prednisolone/acetaminophen combination is as effective as oral indomethacin/acetaminophen combination in relieving pain but is associated with fewer adverse effects.
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Affiliation(s)
- Chi Yin Man
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
| | - Ian T.F. Cheung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter A. Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Timothy H. Rainer
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
Several epidemiological studies have indicated that the long-term use of NSAIDs, most of which are cyclo-oxygenase (COX) inhibitors, may reduce the risk of Alzheimer's disease. For this reason, anti-inflammatory COX-inhibiting NSAIDs have received increased attention in experimental and therapeutic trials for Alzheimer's disease. However, several recent efforts attempting to demonstrate a therapeutic effect of NSAIDs in Alzheimer's disease have largely failed. Clinicians and scientists currently believe that this lack of success may be attributable to two key problems: (i) clinical trials of NSAIDs have been conducted in patients with late-stage Alzheimer's disease, wherein advanced neurodegeneration may be refractory to anti-inflammatory drug treatment; and (ii) it is not known which of the large family of NSAIDs (i.e. COX-1, COX-2 or mixed inhibitors) is most efficacious in preventing Alzheimer's disease. The wide list of putative functions for COX in the brain, and the significant functional heterogeneity of NSAIDs, which appear to influence the beta-amyloid (Abeta) neuropathology associated with Alzheimer's disease via both COX-dependent and COX-independent pathways, complicate the interpretation of the mechanisms through which COX-inhibiting NSAIDs may beneficially influence Alzheimer's disease. As discussed in this review, for patients at high risk of developing Alzheimer's disease (e.g. those with mild cognitive impairment), preventative treatment with COX-inhibiting NSAIDs may ultimately represent a viable strategy in the management of clinical Alzheimer's disease. However, the recent evidence showing an increased risk of major cardiovascular events among patients treated with certain COX-1 and COX-2 inhibitors leaves many questions unanswered. We suggest that further investigation into the physiological role(s) of COXs in normal health and in disease conditions, and the identification of safer and better tolerated COX inhibitors, will provide renewed impetus to the application of anti-inflammatory strategies for the prevention and treatment of Alzheimer's disease.
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Affiliation(s)
- Lap Ho
- Department of Psychiatry, The Mount Sinai School of Medicine, Neuroinflammation Research Laboratories, New York, New York 10029, USA
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Signorello LB, McLaughlin JK, Lipworth L, Friis S, Sørensen HT, Blot WJ. Confounding by indication in epidemiologic studies of commonly used analgesics. Am J Ther 2002; 9:199-205. [PMID: 11941379 DOI: 10.1097/00045391-200205000-00005] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Confounding by indication is a bias frequently encountered in observational epidemiologic studies of drug effects. Because the allocation of treatment in observational studies is not randomized and the indication for treatment may be related to the risk of future health outcomes, the resulting imbalance in the underlying risk profile between treated and comparison groups can generate biased results. Confounding by indication is often present in studies of drugs that are not widely prescribed, because the indications for their use are narrow and not likely to be present in comparison groups; however, this bias is also observed in the study of widely used over-the-counter and prescription drugs, are exemplified by studies of analgesics. In this article we review examples from the published literature to demonstrate how confounding by indication can affect the findings of pharmacoepidemiologic studies relating analgesic use to various health outcomes.
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Affiliation(s)
- Lisa B Signorello
- International Epidemiology Institute, Rockville, Maryland, USA; Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
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Current awareness in pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:169-74. [PMID: 12004884 DOI: 10.1002/pds.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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