1
|
Leong CW, Yee KM, Rani TA, Lau KJ, Ahmad S, Amran A, Mohd Hassan FW, Kumar N. Pharmacokinetics and Bioequivalence of Fixed-Dose Combination of Simvastatin and Ezetimibe Tablets: A Randomized, Crossover, Open-Label Study in Healthy Volunteers. Clin Pharmacol Drug Dev 2024; 13:938-946. [PMID: 38745538 DOI: 10.1002/cpdd.1411] [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: 01/17/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
The current study aimed to evaluate the bioequivalence of a new generic combination of simvastatin and ezetimibe with the reference formulation. An open-label, randomized, 3-period, 3-sequence, crossover study, including 60 healthy volunteers, was implemented. Participants received the test and reference formulation, each containing 20 mg of simvastatin and 10 mg of ezetimibe as a single-dose tablet, separated by a minimum of 2-week washout periods. Blood samples were collected for 20 time points from predose to 72 hours after the dose. The total ezetimibe assay was carried out using a validated liquid chromatography-tandem mass spectrometry, while unconjugated ezetimibe, simvastatin, and simvastatin β-hydroxy acid determination was done via a validated ultra-performance liquid chromatography-tandem mass spectrometry. Each assay was preceded by a liquid-liquid extraction step. The pharmacokinetic parameters were derived using noncompartmental analysis and then compared between the reference and test formulations via a multivariate analysis of variance. No statistical difference was found in under the concentration-time curve from time 0 to the last quantifiable concentration and maximum concentration of unconjugated ezetimibe, total ezetimibe, and simvastatin between the reference and test formulations. The 90% confidence intervals of unconjugated ezetimibe, total ezetimibe, and simvastatin natural log-transformed under the concentration-time curve from time 0 to the last quantifiable concentration, and maximum concentration were in the range of 80%-125% as per the bioequivalence acceptance criteria. Therefore, the test formulation was bioequivalent to the reference formulation.
Collapse
Affiliation(s)
| | - Kar Ming Yee
- Duopharma Innovation Sdn. Bhd., Shah Alam, Selangor, Malaysia
| | - Tracy Ann Rani
- Duopharma Innovation Sdn. Bhd., Shah Alam, Selangor, Malaysia
| | - Kheng Jinm Lau
- Duopharma Innovation Sdn. Bhd., Shah Alam, Selangor, Malaysia
| | - Shahnun Ahmad
- Duopharma Innovation Sdn. Bhd., Shah Alam, Selangor, Malaysia
| | - Atiqah Amran
- Duopharma Innovation Sdn. Bhd., Shah Alam, Selangor, Malaysia
| | | | | |
Collapse
|
2
|
de Souza AMC, Fajardo FAG, Rashid A, Tavares MFM, Prado MSA. Capillary Electrophoresis Method for Simultaneous Quantification of Hypocholesterolemic Drugs in Binary Mixture Formulation: Fast, Green, and Cost-Effective Alternative to HPLC. Chromatographia 2023. [DOI: 10.1007/s10337-023-04243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
3
|
Bahetibieke S, Moinuddin SM, Baiyisaiti A, Liu X, Zhang J, Liu G, Shi Q, Peng A, Tao J, Di C, Cai T, Qi R. Co-Amorphous Formation of Simvastatin-Ezetimibe: Enhanced Physical Stability, Bioavailability and Cholesterol-Lowering Effects in LDLr-/-Mice. Pharmaceutics 2022; 14:pharmaceutics14061258. [PMID: 35745830 PMCID: PMC9230881 DOI: 10.3390/pharmaceutics14061258] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/04/2023] Open
Abstract
Hypercholesterolemia is one of the independent risk factors for the development of cardiovascular diseases such as atherosclerosis. The treatment of hypercholesterolemia is of great significance to reduce clinical cardiovascular events and patient mortality. Simvastatin (SIM) and ezetimibe (EZE) are commonly used clinically as cholesterol-lowering drugs; however, their treatment efficacy is severely affected by their poor water solubility and low bioavailability. In this study, SIM and EZE were made into a co-amorphous system to improve their dissolution, oral bioavailability, storage stability, and cholesterol-lowering effects. The SIM-EZE co-amorphous solids (CO) were prepared successfully using the melt-quenched technique, and the physicochemical properties of CO were characterized accordingly, which exhibited improved physical stability and faster dissolution release profiles than their physical mixture (PM). In the pharmacokinetic study, the SIM-EZE CO or PM was given once by oral gavage, and mouse blood samples were collected retro-orbitally at multiple time points to determine the plasma drug concentrations. In the pharmacodynamic study, low-density lipoprotein receptor-deficient (LDLr−/−) mice were fed with a high-fat diet (HFD) for two weeks to establish a mouse model of hypercholesterolemia. Using PM as a control, we investigated the regulation of CO on plasma lipid levels in mice. Furthermore, the mice feces were collected to determine the cholesterol contents. Besides, the effect of EZE on the NPC1L1 mRNA expression level in the mouse intestines was also investigated. The pharmacokinetics results showed that the SIM-EZE CO has improved bioavailability compared to the PM. The pharmacodynamic studies showed that SIM-EZE CO significantly increased the cholesterol-lowering effects of the drugs compared to their PM. The total cholesterol excretion in the mouse feces and inhibitory effect on NCP1L1 gene expression in the mouse intestines after being given the SIM-EZE CO were more dramatic than the PM. Our study shows that the SIM-EZE CO prepared by the melt-quenched method can significantly improve the stability, bioavailability, and cholesterol-lowering efficacy with excellent development potential as a new drug formulation.
Collapse
Affiliation(s)
- Shamuha Bahetibieke
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
| | - Sakib M. Moinuddin
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
- College of Pharmacy, California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757, USA
| | - Asiya Baiyisaiti
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
- School of Pharmacy, Shihezi University, Shihezi 832000, China
| | - Xiaoang Liu
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
- School of Pharmacy, Shihezi University, Shihezi 832000, China
| | - Jie Zhang
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
| | - Guomin Liu
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
| | - Qin Shi
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
| | - Ankang Peng
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
| | - Jun Tao
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
| | - Chang Di
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
| | - Ting Cai
- School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Xuanwu District, Nanjing 210009, China; (S.M.M.); (J.Z.); (G.L.); (Q.S.); (J.T.)
- Correspondence: (T.C.); (R.Q.); Tel./Fax: +86-25-86185516 (T.C.); +86-10-8280-5164 (R.Q.)
| | - Rong Qi
- Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (S.B.); (A.B.); (X.L.); (A.P.); (C.D.)
- School of Pharmacy, Shihezi University, Shihezi 832000, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- Correspondence: (T.C.); (R.Q.); Tel./Fax: +86-25-86185516 (T.C.); +86-10-8280-5164 (R.Q.)
| |
Collapse
|
4
|
Górniak A, Złocińska A, Trojan M, Pęcak A, Karolewicz B. Preformulation Studies of Ezetimibe-Simvastatin Solid Dispersions in the Development of Fixed-Dose Combinations. Pharmaceutics 2022; 14:pharmaceutics14050912. [PMID: 35631498 PMCID: PMC9147300 DOI: 10.3390/pharmaceutics14050912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2023] Open
Abstract
Two active pharmaceutical ingredients (APIs) with limited solubility, simvastatin and ezetimibe, prepared as a drug-drug solid dispersion (SD) was evaluated for physicochemical, microstructural, and aqueous dissolution properties. The simvastatin-ezetimibe SD was prepared using the co-grinding method in a wide range of weight fractions and differential scanning calorimetry (DSC) and X-ray powder diffraction (XRPD) were used to perform the phase composition analysis. DSC studies confirmed that simvastatin and ezetimibe form a simple eutectic phase equilibrium diagram. Analysis of Fourier transform infrared spectroscopy (FTIR) studies excluded strong interactions between the APIs. Our investigations have revealed that all studied dispersions are characterized by substantially improved ezetimibe dissolution regardless of simvastatin content, and are best when the composition oscillates near the eutectic point. Data obtained in our studies provide an opportunity for the development of well-formulated, ezetimibe-simvastatin fixed-dose combinations (for hypercholesterolemia treatment) with reduced ezetimibe dosages based on its dissolution improvement.
Collapse
Affiliation(s)
- Agata Górniak
- Laboratory of Elemental Analysis and Structural Research, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (A.Z.); (M.T.); (A.P.)
- Correspondence: ; Tel.: +48-717840670
| | - Adrianna Złocińska
- Laboratory of Elemental Analysis and Structural Research, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (A.Z.); (M.T.); (A.P.)
| | - Mateusz Trojan
- Laboratory of Elemental Analysis and Structural Research, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (A.Z.); (M.T.); (A.P.)
| | - Adrianna Pęcak
- Laboratory of Elemental Analysis and Structural Research, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (A.Z.); (M.T.); (A.P.)
| | - Bożena Karolewicz
- Department of Drug Form Technology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland;
| |
Collapse
|
5
|
Cicero AF, Fogacci F, Zambon A, Toth PP, Borghi C. Efficacy and safety of inclisiran a newly approved FDA drug: a systematic review and pooled analysis of available clinical studies. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100127. [PMID: 38560059 PMCID: PMC10978220 DOI: 10.1016/j.ahjo.2022.100127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 04/04/2024]
Abstract
Study objective This systematic review and meta-analysis aimed to assess the efficacy and safety profile of treatment with inclisiran, a drug that has been recently approved by the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Design A systematic literature search was conducted in order to identify randomized controlled trials (RCTs) assessing the effect on lipoproteins and the safety profile of inclisiran. Results Data were pooled from 5 RCTs, which included 4226 subjects. Meta-analyses of data suggested that the multiple-dose regimens of inclisiran yielded a significant reduction in serum levels of proprotein convertase subtilisin/kexin type 9 (MD = -78.23%, 95%CI: -86.74, -69.71) and low-density lipoprotein cholesterol (MD = -45.48%, 95%CI: -50.36%, -40.61%) throughout the studies. Furthermore, treatment with inclisiran significantly affected total cholesterol (MD = -13.67%, 95%CI: -20.78%, -6.57%), high-density lipoprotein cholesterol (MD = 8.29%, 95%CI: 4.66%,11.93%), non-HDL cholesterol (MD = -39.45%, 95%CI: -43.6%, -35.31%), apolipoprotein B (MD = -34.58%, 95%CI: -38.78%, -30.78%) and lipoprotein(a) (MD = -20.9%, 95%CI: -25.8%, -15.99%). Multiple-dose regimens of inclisiran were associated with increased risk of injection-site reactions (any reaction: OR = 5.86, 95%CI: 3.44, 9.98; mild reactions: OR = 5.19, 95%CI: 1.68, 16.07; moderate reactions: OR = 13.37, 95%CI: 3.17, 56.46), and bronchitis (OR = 1.58, 95%CI: 1.10, 2.26), while the incidence of the pre-specified exploratory CV endpoint significantly decreased at 18 months (OR = 0.74, 95%CI: 0.58, 0.94). Conclusion and relevance Inclisiran has favourable effects on serum lipid levels and an acceptable safety profile. Further well-designed RCTs are needed to explore its longer-term safety.
Collapse
Affiliation(s)
- Arrigo F.G. Cicero
- Hypertension and Cardiovascular Risk Factors Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Factors Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Zambon
- IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni, MI, Italy
- Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Factors Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| |
Collapse
|
6
|
Boutari C, Karagiannis A, Athyros VG. Rosuvastatin and ezetimibe for the treatment of dyslipidemia and hypercholesterolemia. Expert Rev Cardiovasc Ther 2021; 19:575-580. [PMID: 34102931 DOI: 10.1080/14779072.2021.1940959] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Statins are powerful lipid-lowering agents which reduce cardiovascular (CV)-related morbidity and mortality. However, a large proportion of patients cannot attain the target low-density lipoprotein cholesterol (LDL-C) levels, despite receiving maximally tolerated doses of high-intensity statins. Also, adherence to treatment may be reduced due to statin-induced myopathy or other side effects. For these reasons, guidelines recommend adding the cholesterol absorption inhibitor ezetimibe.Areas covered: Authors discuss the main pharmacological characteristics of rosuvastatin and ezetimibe, their lipid-lowering and pleiotropic effects, as well as the clinical effects of the fixed dose combination of these drugs when used to treat dyslipidemia.Expert opinion: The rosuvastatin/ezetimibe combination is safe and effective in patients with hypercholesterolemia or dyslipidemia with or without diabetes and with or without cardiovascular disease. This drug combination enabled higher proportions of patients to achieve recommended LDL-C goals than rosuvastatin monotherapy or the simvastatin/ezetimibe combination, without additional adverse events. Despite the lack of additional CV outcomes data and comparisons with atorvastatin/ezetimibe, rosuvastatin/ezetimibe appears as a potent and generally well-tolerated drug combination eligible for the management of hypercholesterolemia and dyslipidemia in adults. Recently, the 40 mg rosuvastatin/10 mg ezetimibe fixed combination was approved and is also evaluated.
Collapse
Affiliation(s)
- Chrysoula Boutari
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
| | - Asterios Karagiannis
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
| | - Vasilios G Athyros
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
| |
Collapse
|
7
|
Yu S, Jin J, Chen Z, Luo X. High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients. Lipids Health Dis 2020; 19:194. [PMID: 32829708 PMCID: PMC7444068 DOI: 10.1186/s12944-020-01369-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 08/12/2020] [Indexed: 02/08/2023] Open
Abstract
Background Whether high-intensity statin treatment provides more clinical benefits compared with standard statin regimens in acute coronary syndrome (ACS) patients remains controversial. This meta-analysis aimed to comparatively assess high-intensity and standard statin regimens for efficacy and safety in patients with ACS. Methods The PubMed, EMBASE, and Cochrane Library databases were searched for studies assessing high-intensity vs. standard statin regimens for ACS treatment from inception to April 2020. The publication language was limited to English, and 16 randomized controlled trials were finally included in this study, with a total of 26,497 patients. Results Compared to the standard statin regimens, the relative ratio (RR) of major adverse cardiovascular events (MACE) in ACS patients treated by high-intensity statin was 0.77 (95%CI, 0.68–0.86; P < 0.00001; prediction interval, 0.56–1.07). In subgroup analysis, high-intensity statin therapy resulted in more clinical benefits regarding MACE compared with standard statin treatment in both Asian (RR = 0.77; 95%CI, 0.61–0.98; P = 0.03) and non-Asian (RR = 0.79; 95%CI, 0.71–0.89; P < 0.0001) patients. Although adverse events were acceptable in patients with ACS administered high-intensity statin therapy, this treatment was associated with a higher rate of adverse events (4.99% vs. 2.98%), including myopathy/myalgia and elevated liver enzymes, as reflected by elevated serum aminotransferase or aminotransferase amounts. Conclusion The current findings indicated that high-intensity statin therapy might be beneficial in patients with ACS, and close monitoring for adverse effects should be performed.
Collapse
Affiliation(s)
- Shiyong Yu
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jun Jin
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
| | - Zhongxiu Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolu Luo
- HuoCheNan Community Health Service Center, Wuhou District, Chengdu, 610041, China
| |
Collapse
|
8
|
Strilchuk L, Tocci G, Fogacci F, Cicero AFG. An overview of rosuvastatin/ezetimibe association for the treatment of hypercholesterolemia and mixed dyslipidemia. Expert Opin Pharmacother 2020; 21:531-539. [DOI: 10.1080/14656566.2020.1714028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Larysa Strilchuk
- Department of Therapy and Medical Diagnostics, Lviv National Medical University, Lviv, Ukraine
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy
- Cardiology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Arrigo F. G. Cicero
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
9
|
Ibrahim N‘I, Fairus S, Zulfarina MS, Naina Mohamed I. The Efficacy of Squalene in Cardiovascular Disease Risk-A Systematic Review. Nutrients 2020; 12:E414. [PMID: 32033387 PMCID: PMC7071298 DOI: 10.3390/nu12020414] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death worldwide. Squalene (SQ), an intermediate for the cholesterol biosynthesis, has been proposed to act similarly to statins via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase in the liver. PURPOSE This paper explores the effects of SQ in CVD. METHODS A systematic review of the literature was performed to identify relevant studies about SQ and CVD. A comprehensive search in Medline and Scopus for relevant studies published between the years 1946 and 2019 was performed. The main inclusion criteria were that the study was published in English; that the study reported association or effect of SQ and CVD; and that CVD should be related to lifestyle variables, aging, or experimentally induced conditions. RESULTS The literature searches identified 5562 potentially relevant articles, whereby 21 studies met the inclusion criteria. There were three human studies and 18 animal experimental studies included in this paper. Only one human study reported positive outcome of SQ in CVD. The remaining two studies reported inconsistent and/or no effect. For animal studies, 15 studies reported positive effect while the remaining reported negative and/or no effect of SQ on various related parameters. CONCLUSIONS This evidence-based review emphasizes the potential of SQ being used for cardiovascular-related diseases. The effect of SQ, especially of plant-based warrants further exploration. Controlled human observational studies should be performed to provide comprehensive evidence.
Collapse
Affiliation(s)
- Nurul ‘Izzah Ibrahim
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia
| | - Syed Fairus
- Malaysian Palm Oil Board (MPOB), No. 6 Persiaran Institusi, Bandar Baru Bangi, Kajang 43000, Selangor, Malaysia
| | - Mohamed S. Zulfarina
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia
| | - Isa Naina Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia
| |
Collapse
|
10
|
Araya-Quintanilla F, Gutiérrez-Espinoza H, Moyano-Gálvez V, Muñoz-Yánez MJ, Pavez L, García K. Effectiveness of black tea versus placebo in subjects with hypercholesterolemia: A PRISMA systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:2250-2258. [PMID: 31235165 DOI: 10.1016/j.dsx.2019.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/22/2019] [Indexed: 01/27/2023]
Abstract
AIM To determine if the black tea is more effective in serum lipid profile that placebo in subjects with hypercholesterolemia. DESIGN Systematic review with meta-analysis of randomized clinical trials (RCTs). DATA SOURCES The databases Medline, Central, Embase, Lilacs, Cinahl, SPORTDiscus, and Web of Science were searched from inception up to January 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RCTs that compared black tea versus placebo, that included serum lipid profile outcomes in subjects older than 18 years of age with hypercholesterolemia. RESULTS Seven RCTs met the eligibility criteria, and for the quantitative synthesis, six studies were included. Mean difference for total cholesterol was 1.67 mg/dl 95% CI = -5.47 to 8.80 (p = 0.65), mean difference 0.28 mg/dl, 95% CI = -3.89 to 4.45 (p = 0.90) for triglycerides, mean difference 3.21 mg/dl, 95% CI = -11.02 to 4.60 (p = 0.42) for low density lipoprotein-cholesterol, mean difference 0.38 mg/dl, 95% CI = -1.12 to 1.87 (p = 0.62) for high density lipoprotein-cholesterol. CONCLUSION In the short term, no significant differences were found in lipid serum profile comparing black tea consumption with placebo.
Collapse
Affiliation(s)
- Felipe Araya-Quintanilla
- Faculty of Health Sciences, Universidad Gabriela Mistral. Santiago, Chile; Faculty of Health, Universidad de las Americas. Santiago, Chile.
| | - Héctor Gutiérrez-Espinoza
- Faculty of Health, Universidad de las Americas. Santiago, Chile; Center of Diagnostic and Treatment, Clinical Hospital San Borja Arriaran. Santiago, Chile
| | | | | | - Leonardo Pavez
- Instituto de Ciencias Naturales, Universidad de las Américas. Santiago, Chile; Departamento de Ciencias Químicas y Biológicas, Universidad Bernardo O'Higgins. Santiago, Chile
| | - Katherine García
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile, Santiago, Chile
| |
Collapse
|
11
|
Abstract
INTRODUCTION Despite the consolidated role of statins and ezetimibe to treat hypercholesterolemia, often the desirable low-density lipoprotein cholesterol (LDL-C) values are not achieved, with a consequent increase of the residual cardiovascular (CV) risk. Areas covered: In this review, we summarize the main pharmacological characteristics of new lipid-lowering drugs, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, cholesteryl ester transfer protein inhibitors, microsomal triglyceride transfer protein inhibitors, ATP citrate lyase inhibitors, antisense oligonucleotides, small interfering RNA, and peroxisome proliferator-activated receptors type α agonists. The available clinical evidence of efficacy and safety as well as the prospects of application, based on the different mechanisms and targets of action, is critically discussed. Expert opinion: Some of these emerging agents represent an excellent therapeutic strategy to treat patients with LDL largely out of target, resistant or intolerant to statins, trying to minimize the residual CV risk, modulating different classes of lipoproteins, not just LDL. The main challenge for the large use of emerging drugs is their cost. Thus, the correct identification of the adequate target population for treatment is a priority. This is particularly true for safe, powerful, and fully developed drugs such as the PCSK9 inhibitors, for which a relatively large use is potentially expected.
Collapse
Affiliation(s)
- Marilisa Bove
- a Medical and Surgical Sciences Department , University of Bologna , Bologna , Italy
| | - Arrigo F G Cicero
- a Medical and Surgical Sciences Department , University of Bologna , Bologna , Italy
| | - Claudio Borghi
- a Medical and Surgical Sciences Department , University of Bologna , Bologna , Italy
| |
Collapse
|
12
|
Al-Hashimi NN, Shahin RO, Al-Hashimi AN, Al Ajeal AM, Tahtamouni LH, Basheer C. Cetyl-alcohol-reinforced hollow fiber solid/liquid-phase microextraction and HPLC-DAD analysis of ezetimibe and simvastatin in human plasma and urine. Biomed Chromatogr 2018; 33:e4410. [PMID: 30315647 DOI: 10.1002/bmc.4410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/26/2018] [Accepted: 10/09/2018] [Indexed: 11/11/2022]
Abstract
A new cetyl-alcohol-reinforced hollow fiber solid/liquid-phase microextraction (CA-HF-SLPME) followed by high-performance liquid chromatography-diode array detection (HPLC-DAD) method was developed for simultaneous determination of ezetimibe and simvastatin in human plasma and urine samples. To prepare the CA-HF-SLPME device, the cetyl-alcohol was immobilized into the pores of a 2.5 cm hollow fiber micro-tube and the lumen of the micro-tube was filled with 1-octanol with the two ends sealed. Afterwards, the prepared device was introduced into 10 mL of the sample solution containing the analytes with agitation. Under optimized conditions, calibration curves plotted in spiked plasma and urine samples were linear in the ranges of 0.363-25/0.49-25 μg L-1 for ezetimibe/simvastatin and 0.193-25/0.312-25 μg L-1 for ezetimibe/simvastatin in plasma and urine samples, respectively. The limit of detection was 0.109/0.174 μg L-1 for ezetimibe/simvastatin in plasma and 0.058/0.093 μg L-1 for ezetimibe/simvastatin in urine. As a potential application, the proposed method was applied to determine the concentration of selected analytes in patient plasma and urine samples after medication and satisfactory results were achieved. In comparison with reference methods, the CA-HF-SLPME-HPLC-DAD method demonstrates considerable potential in the biopharmaceutical analysis of selected drugs.
Collapse
Affiliation(s)
- Nabil N Al-Hashimi
- Faculty of Pharmaceutical Sciences, Department of Pharmaceutical Chemistry, The Hashemite University, Al-Zarqa, Jordan
| | - Rand O Shahin
- Faculty of Pharmaceutical Sciences, Department of Pharmaceutical Chemistry, The Hashemite University, Al-Zarqa, Jordan
| | - Aqeel N Al-Hashimi
- University College of Science, Department of Biochemistry, Osmania University, Hyderabad, India
| | - Ajeal M Al Ajeal
- Faculty of Medicine, Department of Internal and Family Medicine, The Hashemite University, Al-Zarqa, Jordan
| | - Lubna H Tahtamouni
- Faculty of Science, Department of Biology and Biotechnology, The Hashemite University, Al-Zarqa, Jordan
| | - Chanbasha Basheer
- College of Sciences, Department of Chemistry, King Fahd University of Petroleum and Minerals, Dhahran, Kingdom of Saudi Arabia
| |
Collapse
|
13
|
Zodda D, Giammona R, Schifilliti S. Treatment Strategy for Dyslipidemia in Cardiovascular Disease Prevention: Focus on Old and New Drugs. PHARMACY 2018; 6:pharmacy6010010. [PMID: 29361723 PMCID: PMC5874549 DOI: 10.3390/pharmacy6010010] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
Prevention and treatment of dyslipidemia should be considered as an integral part of individual cardiovascular prevention interventions, which should be addressed primarily to those at higher risk who benefit most. To date, statins remain the first-choice therapy, as they have been shown to reduce the risk of major vascular events by lowering low-density lipoprotein cholesterol (LDL-C). However, due to adherence to statin therapy or statin resistance, many patients do not reach LDL-C target levels. Ezetimibe, fibrates, and nicotinic acid represent the second-choice drugs to be used in combination with statins if lipid targets cannot be reached. In addition, anti-PCSK9 drugs (evolocumab and alirocumab) provide an effective solution for patients with familial hypercholesterolemia (FH) and statin intolerance at very high cardiovascular risk. Recently, studies demonstrated the effects of two novel lipid-lowering agents (lomitapide and mipomersen) for the management of homozygous FH by decreasing LDL-C values and reducing cardiovascular events. However, the costs for these new therapies made the cost–effectiveness debate more complicated.
Collapse
Affiliation(s)
- Donatella Zodda
- Drug Department of Local Health Unit (ASP), Viale Giostra, 98168 Messina, Italy.
| | - Rosario Giammona
- Clinical Pharmacy Fellowship, University of Messina, Viale Annunziata, 98168 Messina, Italy.
| | - Silvia Schifilliti
- Clinical Pharmacy Fellowship, University of Messina, Viale Annunziata, 98168 Messina, Italy.
| |
Collapse
|