Amtolmetin: A Reappraisal of NSAID with Gastroprotection

Pharmaceuticals agents for preventing NSAID-induced gastric ulcers: a patent review

INTRODUCTION

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of drugs widely used due to their pharmacological potential, demonstrating anti-inflammatory, analgesic, or antipyretic activity. However, prolonged use of these medications can lead to the development of gastric ulcers in patients. This review aimed to find patents for drugs with an anti-inflammatory and gastroprotective character to treat NSAID-induced gastric ulcers.

AREAS COVERED

For the treatment of NSAID-induced gastric ulcers, formulations with different action mechanisms were found, including donors of nitric oxide, heterocyclic compounds, and natural products.

EXPERT OPINION

Many of the structures found have already been used in clinic settings and others, and according to the results found, they are promising for the treatment of gastric ulcers.

Prostaglandins influence protein phosphorylation in established insect cell line

Prostaglandins (PGs) are oxygenated metabolites of arachidonic acid and two other C20 polyunsaturated fatty acids. Among other actions in invertebrates, PGs act in ovarian development, renal functions, immunity, hemocyte migration, and gene/protein expression. Reversible phosphorylation is a major mechanism of regulating protein functions in eukaryotic cells and for some mammalian proteins it is influenced by PGs. We posed the hypothesis that PGs influence protein phosphorylation within insect cells, which we tested with the established insect cell line, BCIRL-HzAM1. After 20, 30, or 40 min incubations in the presence of one of three PGs (at 15 μM), PGA₂ , PGE₁ , or PGF_2α , separate sets of cells were processed for analysis by two-dimensional electrophoresis followed by tandem mass spectrometry. We recorded significant phosphorylation changes in 31 proteins, decreases in 15, and increases in 15, and one protein with increased or decreased phosphorylation, depending on PG treatment. Increasing PG exposure times led to changes in fewer proteins, 20 min incubations led to changes in 16 proteins, 30 min to changes in 13, and 40 min to changes in 2 proteins. The proteins were identified by bioinformatic analyses, including transcript description, calculated molecular weights and isoelectric points, MOlecular Weight SEarch score, total ion score, numbers of peptides, percent protein coverage, E-value, and highest peptide score. The data presented in this paper firmly support our hypothesis that PGs influence protein phosphorylation within insect cells and adds a novel PG-signaled function to insect biology.

International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations.

Methods

A modified ‘Delphi’ process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists.

Results

The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events.

Conclusion/clinical significance

These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients.

How to cite this article: Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160.