Do non-steroidal anti-inflammatory drugs influence chronic inflammation? The effects of piroxicam on chronic antigen-induced arthritis in rats

Rapid Sublingual Delivery of Piroxicam from Electrospun Cyclodextrin Inclusion Complex Nanofibers

Piroxicam (Px) is a nonsteroidal anti-inflammatory drug (NSAID) used for the treatment of osteoarthritis and rheumatoid arthritis. It is administered orally; however, its poor water solubility causes low loading to the nonconventional drug delivery systems (DDSs), such as electrospun fibers. Furthermore, the rapid dissolution of DDS and fast release of the embedded drugs are crucial for oral delivery of drugs to patients who are unconscious or suffering from dysphagia. In this regard, this study reports the development of rapidly dissolving cyclodextrin (CD)-based inclusion complex (IC) nanofibers by waterborne electrospinning for fast oral delivery of Px. Scanning electron microscopy analysis revealed the formation of bead-free fibers with a mean diameter range of 170-500 nm at various concentrations of Px; increasing the Px loading decreased the fiber diameter. The formation of IC was demonstrated by X-ray diffraction (XRD) analysis by the disappearance of crystalline peaks of Px. Likewise, differential scanning calorimetry (DSC) analysis showed the disappearance of the melting peak of the embedded Px due to IC formation. Both Fourier transform infrared (FTIR) and thermogravimetric analysis (TGA) confirmed the presence of Px within the fibers. ¹H NMR experiments demonstrated Px preservation in the fibers after six months. Px-loaded nanofibers were employed for sublingual drug delivery. To mimic the environment of the mouth, the nanofibers were treated with artificial saliva, which revealed the instant dissolution of the nanofibers. Furthermore, dissolution experiments were performed on the tissues wetted with artificial saliva, where the dissolution of the fibers could be extended to a few seconds, demonstrating the suitability of the materials for sublingual oral drug delivery. Overall, this paper, for the first time, reports the rapid oral delivery of Px from polymer-free CD fibers produced by waterborne electrospinning without the requirement of any carrier polymer and toxic solvent.

Cuminum cyminum L.-Mediated Synthesis of Silver Nanoparticles: Their Characterization and Effect on Formalin-Induced Nociceptive Response in Male Rats

In this study, a simple, low-cost, rapid, and eco-friendly approach for the biosynthesis of silver nanoparticles (AgNPs) using the aqueous extract of Cuminum cyminum L. (cumin) seed (CcAgNPs) was developed. Also, the anti-nociceptive properties of these synthesized AgNPs were evaluated in vivo. The CcAgNPs characterized using Ultraviolet-visible (UV-Vis) spectrophotometer, X-ray diffraction analysis (XRD), Fourier transform infrared (FTIR) spectroscopy, atomic force microscopy (AFM), and transmission electron microscopy (TEM). The analysis of phytochemical components in the aqueous extract of cumin seeds showed high concentrations of total phenols and ascorbic acid and low concentrations of total flavonoids. The analysis of phytochemical components and FTIR spectroscopy confirmed the presence of functional groups responsible for the bioreduction of Ag⁺ to AgNPs. The UV-Vis absorbance spectrum of CcAgNPs showed a maximum wavelength at 442 nm. The analysis of TEM images showed a spherical shape with a size of less than 50 nm, while XRD spectra revealed the crystallinity of CcAgNPs. The analysis of anti-nociceptive properties of CcAgNPs showed that the first phase of formalin-induced pain was significantly reduced in the groups receiving 200, 500, and 1000 mg/kg CcAgNPs compared with the controls and the group receiving 300 mg/kg of sodium salicylate (SS300). The second phase of formalin pain was also significantly reduced in the groups receiving 200 and 500 mg/kg CcAgNPs compared to the controls and SS300 group. Overall, we introduced a new AgNPs synthesized from cumin seeds (CcAgNPs) and showed their anti-nociceptive properties in the formalin-induced pain.

Regulation of Inflammatory Reaction in Health and Disease

Inflammation is a key mechanism for the clearance of infective agents and other inflammatory triggers and is pivotal for the repairing processes of the affected tissues. Inflammation is a multistep process driven by a great number of mediators which regulate specific aspects of the inflammatory response, in agreement with a well-defined chronobiological program. A great number of inflammation-related diseases show a deeply altered immune chronobiology (e.g., COVID-19-related cytokines storm). This aspect highlights the need for a deeper understanding of the inflammatory phenomenon. It is fundamental to study inflammation as a multilevel phenomenon. Of particular interest is the low-grade chronic inflammation, which is an etiological factor of many chronic diseases. Nowadays, the therapeutic approach to low grade chronic inflammation is one of the great challenges of traditional pharmacology. Currently, no drugs specifically designed for the treatment of chronic inflammatory forms are available. Today, bioregulatory systems medicine (BrSM) and low dose medicine (LDM), two pharmacological paradigms grounded in systems medicine, potentially represent new tools for the treatment of inflammation-related diseases. Scientific research has assessed the effectiveness and safety of both these therapeutic approaches, in particular for the management of chronic inflammatory conditions and chronic immunological dysregulations.

Piroxicam

A comprehensive profile of piroxicam including the nomenclatures, formulae, elemental composition, appearance, uses and applications. The methods which were utilized for the preparation of the drug substance and their respective schemes are outlined. The physical characteristics of the drug including the ionization constant, solubility, x-ray powder diffraction pattern, differential scanning calorimetry, thermal behavior and spectroscopic studies are described. The methods which were used for the analysis of the drug substance in bulk drug and/or in pharmaceutical formulations including the compendial, spectrophotometric, electrochemical and the chromatographic methods are reported. The stability, toxicity, pharmacokinetics, bioavailability, drug evaluation, comparison, in addition to compiled reviews on the drug substance are involved. Finally, more than four hundred and fifty references are listed at the end of this profile.

Further assessment of the clinically effective dose range of etoricoxib: a randomized, double-blinded, placebo-controlled trial in rheumatoid arthritis

OBJECTIVE

To further assess the clinically active dose range of etoricoxib, a COX-2 selective inhibitor, in rheumatoid arthritis (RA).

METHODS

RA patients were randomized to etoricoxib 10, 30, 60, or 90 mg or placebo in a double-blind, 12-week study. DMARDs (methotrexate, biologics) or low-dose corticosteroids were allowed in stable doses. The primary endpoint was the proportion of patients completing the study and achieving an American College of Rheumatology 20% (ACR20) response. Secondary endpoints included individual components of the ACR index and Patient Global Assessment of Pain. Safety was assessed by physical exam and adverse experiences (AEs) occurrences.

RESULTS

Etoricoxib 90 mg was the only dose to reach a statistically significant difference from placebo (p < 0.001) on the primary endpoint; etoricoxib 60 mg approached significance (p = 0.057). Significant pain improvement vs. placebo was observed with etoricoxib 90 mg (p < 0.001), 60 mg (p = 0.018), and 30 mg (p = 0.017). Despite the use of background biologics and corticosteroids, a dose response was still apparent. A higher proportion of etoricoxib 60 and 90 mg patients had renovascular AEs (i.e., edema and hypertension) compared with placebo, although discontinuations for renovascular AEs were rare. Etoricoxib 90 mg had a higher incidence of serious AEs (n = 5; 1 was considered drug-related) versus placebo (n = 0).

LIMITATIONS

The present study was not powered to detect differences in cardiovascular or gastrointestinal safety by dose. Additionally, further research is needed to clarify the role of doses less than the etoricoxib 90 mg dose for pain management in RA patients.

CONCLUSION

Etoricoxib 90 mg demonstrated statistically superior efficacy (ACR20) compared with placebo and numerical superiority over the other doses of etoricoxib studied. Etoricoxib 30 and 60 mg demonstrated significant pain improvement versus placebo, suggesting utility for some patients.

Non-steroidal anti-inflammatory drugs and the enteropathy

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most widely used anti-inflammatory agents in clinic. Recently, they are also used to prevent the progression of cardiovascular disease and the pain of muscle, bone and arthrosis. However, long-term and generous use may cause mucosal damages of the stomach and duodenum. With the improvement of clinical diagnostic and therapeutic approaches, it has been found that more and more damages of the intestinal mucosa were being identified. This article reviews the enteropathy caused by NSAIDs and its pathogenic mechanism, prevention and treatment.