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Shankar M, Ali S, Shah S. Women's health and kidney protective medications. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00163. [PMID: 38700904 DOI: 10.1097/mnh.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW We discuss the sex-based differences in the pharmacokinetics and pharmacodynamics of kidney protective medications and their implications on women's health. RECENT FINDINGS A critical examination of adverse drug reactions highlights the underrepresentation of women in clinical trials for kidney and cardiovascular protective drugs, such as SGLT2 inhibitors, ACE inhibitors, and endothelin receptor antagonists. This underscores the need for sex-specific analyses in clinical studies to accurately assess medication efficacy and safety. SUMMARY The research demonstrates that women are more likely to experience adverse events and less likely to benefit from certain treatments, emphasizing the urgent need for healthcare providers to adopt a sex-informed approach in prescribing practices. Future research should prioritize sex differences from the outset to enhance understanding and improve clinical outcomes for women with chronic kidney disease and cardiovascular conditions.
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Affiliation(s)
- Mythri Shankar
- Department of Nephrology, Institute of Nephro-Urology, Bengaluru, Karnataka, India
| | - Sehrish Ali
- Division of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Silvi Shah
- Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Nautiyal A, Bagchi S, Bansal SB. Gender and kidney transplantation. FRONTIERS IN NEPHROLOGY 2024; 4:1360856. [PMID: 38711923 PMCID: PMC11070561 DOI: 10.3389/fneph.2024.1360856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Kidney transplantation provides the best form of kidney replacement therapy with improvement in quality of life and longevity. However, disparity exists in its availability, utilisation and outcomes, not only due to donor availability or financial constraints but also arising from the influence of biological sex and its sociocultural attribute i.e., Gender. Women make up the majority of kidney donors but are less likely to be counselled regarding transpantation, be waitlisted or receive living/deceased donor kidney. Biological differences also contribute to differences in kidney transplantation among the sexes. Women are more likely to be sensitised owing to pregnancy, especially in multiparous individuals, complicating donor compatibility. A heightened immune system in women, evidenced by more autoimmune illnesses, increases the risk of allograft rejection and loss. Differences in the pharmacokinetics of transplant drugs owing to biological variances could also contribute to variability in outcomes. Transgender medicine is also increasingly becoming a relevant topic of study, providing greater challenges in the form of hormonal manipulations and anatomic changes. It is thus important to determine and study transplantation and its nuances in this backdrop to be able to provide relevant sex and gender-specific interventions and design better practices for optimum kidney transplant utilisation and outcomes.
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Affiliation(s)
- Arushi Nautiyal
- Department of Nephrology, Jaipur Golden Hospital, New Delhi, India
| | - Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Kyler KE, Szefler SJ. Fifty Years of Unraveling the Clinical Pharmacology of Corticosteroids. J Pharm Sci 2024; 113:47-54. [PMID: 37844761 DOI: 10.1016/j.xphs.2023.10.016] [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: 08/15/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
This review will highlight portions of Dr. William Jusko's and colleagues' work that affected the clinical use and study of corticosteroids in acute and chronic disease management. Selected publications related to corticosteroid pharmacokinetics and pharmacodynamics from the 1970s through today were included in this review, with a focus on the foundational human-based studies conducted in the 1970s-1990s. Dr. Jusko contributed significantly to early corticosteroid pharmacology across several domains including: 1) foundational corticosteroid pharmacokinetic methods and parameter development, 2) disease state-variation in corticosteroid pharmacokinetics, 3) drug interaction effects on corticosteroid pharmacokinetics, and 4) early corticosteroid pharmacodynamic studies. In an era where little was known about the pharmacokinetics and pharmacodynamics of corticosteroids, Dr. Jusko's work opened the eyes of researchers and clinicians to the potential for disease and drug interactions that could reduce or enhance the effects of corticosteroids. This significant body of work paved the way for alternative routes of administration that would be useful in concentrating the activity at the site of action and markedly reduced systemic drug exposure, minimizing the risk of adverse effects through application of the dose-sparing pharmacokinetic and pharmacodynamic principles.
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Affiliation(s)
- Kathryn E Kyler
- Division of Hospital Medicine, Children's Mercy Kansas City, Kansas City, MO, United States; School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Stanley J Szefler
- University of Colorado School of Medicine, Department of Pediatrics Pediatric Pulmonary and Sleep Medicine Section, United States; Children's Hospital Colorado, Breathing Institute, United States.
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Li Y, Lu L, Androulakis IP. The Physiological and Pharmacological Significance of the Circadian Timing of the HPA Axis: A Mathematical Modeling Approach. J Pharm Sci 2024; 113:33-46. [PMID: 37597751 PMCID: PMC10840710 DOI: 10.1016/j.xphs.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023]
Abstract
As a potent endogenous regulator of homeostasis, the circadian time-keeping system synchronizes internal physiology to periodic changes in the external environment to enhance survival. Adapting endogenous rhythms to the external time is accomplished hierarchically with the central pacemaker located in the suprachiasmatic nucleus (SCN) signaling the hypothalamus-pituitary-adrenal (HPA) axis to release hormones, notably cortisol, which help maintain the body's circadian rhythm. Given the essential role of HPA-releasing hormones in regulating physiological functions, including immune response, cell cycle, and energy metabolism, their daily variation is critical for the proper function of the circadian timing system. In this review, we focus on cortisol and key fundamental properties of the HPA axis and highlight their importance in controlling circadian dynamics. We demonstrate how systems-driven, mathematical modeling of the HPA axis complements experimental findings, enhances our understanding of complex physiological systems, helps predict potential mechanisms of action, and elucidates the consequences of circadian disruption. Finally, we outline the implications of circadian regulation in the context of personalized chronotherapy. Focusing on the chrono-pharmacology of synthetic glucocorticoids, we review the challenges and opportunities associated with moving toward personalized therapies that capitalize on circadian rhythms.
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Affiliation(s)
- Yannuo Li
- Chemical & Biochemical Engineering Department, Piscataway, NJ 08854, USA
| | - Lingjun Lu
- Chemical & Biochemical Engineering Department, Piscataway, NJ 08854, USA
| | - Ioannis P Androulakis
- Chemical & Biochemical Engineering Department, Piscataway, NJ 08854, USA; Biomedical Engineering Department, Rutgers University, Piscataway, NJ 08540, USA.
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5
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Mager DE, Straubinger RM. Contributions of William Jusko to Development of Pharmacokinetic and Pharmacodynamic Models and Methods. J Pharm Sci 2024; 113:2-10. [PMID: 37778439 DOI: 10.1016/j.xphs.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Donald E Mager
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Enhanced Pharmacodynamics, LLC, Buffalo, New York, USA.
| | - Robert M Straubinger
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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6
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Scholes G, Ng E, Bach LA, Sztal-Mazer S. Mixed insulin can improve control of prednisolone-induced hyperglycaemia. Intern Med J 2023; 53:2264-2269. [PMID: 36880383 DOI: 10.1111/imj.16050] [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: 08/15/2022] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Hyperglycaemia is a common side effect of prednisolone, although there are no widely accepted guidelines for the management of glucocorticoid-induced hyperglycaemia (GIH). Our institution uses mixed insulin in a pre-breakfast or pre-breakfast and pre-lunch regimen, with the rationale that this profile of insulin action matches the physiological effect of prednisolone on blood glucose levels (BGLs). AIM Evaluate the use of the mixed insulin (NovoMix30) in a pre-breakfast or pre-breakfast and pre-lunch regimen as management for GIH in a tertiary hospital setting. METHOD We retrospectively evaluated all inpatients coprescribed prednisolone ≥7.5 mg and NovoMix30 for at least 48 hours over a 19-month period. BGLs were evaluated with repeated-measures analysis within four time periods across the day, beginning from the day prior to NovoMix30 administration. RESULTS A total of 53 patients were identified. NovoMix30 significantly reduced BGLs in the morning (mean 12.7 ± 4.5 vs. 9.2 ± 3.9 mmol/L, P < 0.001), afternoon (mean 13.6 ± 3.8 vs. 11.9 ± 3.8 mmol/L, P = 0.001) and evening (12.1 ± 3.8 vs. 10.8 ± 3.8 mmol/L, P = 0.01). With uptitration of insulin over 3 days, 43% of all BGLs were within the target range, compared with 23% on day 0 (P < 0.001). The final median dose of NovoMix30 was 0.15 (0.10-0.22) units/kg bodyweight, or 0.40 (0.23-0.69) units/mg of prednisolone, which is lower than our hospital guideline recommends. One overnight hypoglycaemic event was observed. CONCLUSION Mixed insulin as a pre-breakfast or pre-breakfast and pre-lunch regimen can target the hyperglycaemic pattern induced by prednisolone and minimise overnight hypoglycaemia. However, higher doses of insulin than those used in our study are likely required for optimal BGL control.
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Affiliation(s)
- Gemma Scholes
- Department of Medicine, Alfred Health, Melbourne, Australia
| | - Elisabeth Ng
- Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Australia
| | - Leon A Bach
- Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Australia
- Department of Medicine (Alfred), Monash University, Melbourne, Australia
| | - Shoshana Sztal-Mazer
- Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Erickson P, Jetley G, Amin P, Mejevdiwala A, Patel A, Cheng K, Parekkadan B. A cell culture system to model pharmacokinetics using adjustable-volume perfused mixing chambers. Toxicol In Vitro 2023; 91:105623. [PMID: 37236431 PMCID: PMC10526707 DOI: 10.1016/j.tiv.2023.105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/03/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
The pharmacokinetic (PK) profile of a drug is an essential factor in determining its efficacy, yet it is often neglected during in vitro cell culture experiments. Here, we present a system in which standard well plate cultures may be "plugged in" and perfused with PK drug profiles. Timed drug boluses or infusions are passed through a mixing chamber that simulates the PK volume of distribution specific to the desired drug. The user-specified PK drug profile generated by the mixing chamber passes through the incubated well plate culture, exposing cells to in vivo-like PK drug dynamics. The effluent stream from the culture may then optionally be fractionated and collected by a fraction collector. This low-cost system requires no custom parts and perfuses up to six cultures in parallel. This paper demonstrates a range of PK profiles the system can produce using a tracer dye, describes how to find the correct mixing chamber volumes to mimic PK profiles of drugs of interest, and presents a study exploring the effects of differing PK exposure on a model of lymphoma treatment with chemotherapy.
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Affiliation(s)
- Patrick Erickson
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Gunjan Jetley
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Param Amin
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Aamena Mejevdiwala
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Ashna Patel
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Kelli Cheng
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Biju Parekkadan
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; Department of Medicine, Rutgers Biomedical Health Sciences, New Brunswick, NJ 08852, USA.
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van der Leeuw MS, Tekstra J, van Laar JM, Welsing PMJ. Concomitant prednisone may alleviate methotrexate side-effects in rheumatoid arthritis patients. BMC Rheumatol 2023; 7:8. [PMID: 37198659 DOI: 10.1186/s41927-023-00331-0] [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: 09/14/2022] [Accepted: 04/03/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES To evaluate whether addition of low-moderate dose prednisone to methotrexate (MTX) treatment can alleviate common MTX side-effects in rheumatoid arthritis (RA) patients. METHODS We performed a post-hoc analysis of the CAMERA-II trial which randomized (1:1) 236 early DMARD and prednisone naive RA patients to treatment with MTX + prednisone 10 mg daily, or MTX monotherapy during two years. MTX dose was increased using a treat-to-target approach. We used Generalized Estimating Equations to model the occurrence of common MTX side-effects and of any adverse event over time, controlling for disease activity and MTX dose over time and other possible predictors of adverse events. To assess whether a possible effect was prednisone-specific, we performed the same analysis in the U-ACT-EARLY trial, in which the addition of tocilizumab (TCZ) to MTX was compared to MTX monotherapy in a comparable setting. RESULTS MTX side-effects were reported at 5.9% of visits in the prednisone-MTX group, compared to 11.2% in the MTX monotherapy group. After controlling for MTX dose and disease activity over time, treatment duration, age, sex, and baseline transaminase levels, addition of prednisone significantly decreased the occurrence of MTX side-effects (OR: 0.54, CI: 0.38-0.77, p = 0.001). Specifically, the occurrence of nausea (OR 0.46, CI: 0.26-0.83, p = 0.009)) and elevated ALT/AST (OR 0.29, CI: 0.17-0.49, p < 0.001) was decreased. There was a trend towards fewer overall adverse events in the prednisone-MTX arm (OR: 0.89, CI: 0.72-1.11, p = 0.30). No difference in MTX side-effects was found between TCZ-MTX and MTX monotherapy in U-ACT-EARLY (OR 1.05, CI: 0.61-1.80, p = 0.87). CONCLUSION Addition of 10 mg prednisone daily to MTX treatment in RA patients may ameliorate MTX side-effects, specifically nausea and elevated ALT/AST.
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Affiliation(s)
- Matthijs S van der Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands.
| | - Janneke Tekstra
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
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Stähli A, Scherler C, Zappalà G, Sculean A, Eick S. In vitro activity of anti-rheumatic drugs on release of pro-inflammatory cytokines from oral cells in interaction with microorganisms. FRONTIERS IN ORAL HEALTH 2022; 3:960732. [PMID: 36118051 PMCID: PMC9478466 DOI: 10.3389/froh.2022.960732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Periodontitis patients suffering concomitantly from rheumatoid arthritis (RA) often present with less inflamed periodontal tissues due to the ongoing anti-rheumatic therapy. This in vitro study was aimed to analyze whether anti-inflammatory drugs used in the therapy of RA can modulate the release of IL-8 and IL-1β by professional and non-professional immune cells stimulated with microorganisms. Periodontal ligament (PDL) fibroblasts, monocytic MONO-MAC-6-cells, and gingival keratinocytes were exposed to ibuprofen, prednisolone, and methotrexate with and without lysates of Fusobacterium nucleatum or Candida albicans. Supernatants were obtained and the levels of interleukin(IL)-8 and IL-1β (only MONO-MAC-6) were quantified. The addition of F. nucleatum lysate resulted in the strongest release of proinflammatory cytokines by PDL fibroblast and MONO-MAC-6 cells, while the modification by the tested anti-rheumatic drugs was only minor. After stimulation of the MONO-MAC-cells with F. nucleatum, prednisolone increased the release of IL-8, whereas methotrexate decreased the level. Anti-inflammatory drugs increased the adherence of C. albicans to epithelial cells. In patients with RA, the reduction of the microbial load in subgingival biofilm (biofilm removal) is of major importance; however, the intake of inflammatory drugs may interfere with the inflammatory response.
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Vishneski SR, Saha AK, Fram MR, Templeton LB, Lee LK, Ririe DG, Goenaga‐Diaz EJ, Smith LD, Templeton TW. Risk factors for administration of additional reversal following neuromuscular blockade with rocuronium in children: A retrospective case-control study. Paediatr Anaesth 2022; 32:916-925. [PMID: 35438816 PMCID: PMC9544061 DOI: 10.1111/pan.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence and risk factors for residual neuromuscular blockade in children remain poorly characterized. We hypothesize that specific patient and anesthetic risk factors may be associated with the administration of additional reversal in children following initial reversal of rocuronium with neostigmine. METHODS Our electronic health record was queried for patients <18 years of age who received rocuronium and reversal with neostigmine from 2017 through 2020. Patients receiving other nondepolarizing neuromuscular blocking drugs were excluded. The outcome of interest was defined as the administration of additional neostigmine or sugammadex following primary reversal with neostigmine. Time between the last dose of rocuronium and initial dose of neostigmine, and the cumulative dose of rocuronium were dichotomized. These were combined with other covariates including age, weight, sex, racial group, procedure type, ASA physical status, >1 rocuronium dose administered during the procedure, initial neostigmine dose <0.05 mg kg-1 , use of train-of-four monitoring, duration of anesthesia, inpatient or outpatient, emergency case, neuromuscular disease, and extremes of weight, to assess possible associations with the primary outcome. RESULTS During the study period, 101/6373 (1.58%) patients received rocuronium and additional reversal. Dichotomization of time between last dose of rocuronium and neostigmine yielded <28 min since the last dose of rocuronium and cumulative dose of rocuronium >0.45 mg kg-1 hr-1 . These were associated with the administration of additional reversal with an OR 1.52 (95% CI, 1.08-2.35) and OR 1.71 (95% CI, 1.10-2.67), respectively. Other risk factors included an initial neostigmine dose <0.05 mg kg-1 , OR 4.98 (95% CI, 2.84-6.49), and African American race, OR 1.78 (95% CI, 1.07-2.87). CONCLUSION Risk factors associated with the administration of additional reversal included time <28 min from the last dose of rocuronium to initial dose of neostigmine, cumulative dose of rocuronium >0.45 mg kg-1 hr-1 , initial neostigmine dose <0.05 mg kg-1 , and African American race.
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Affiliation(s)
- Susan R. Vishneski
- Department of AnesthesiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Amit K. Saha
- Department of AnesthesiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Leah B. Templeton
- Department of AnesthesiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Lisa K. Lee
- Department of AnesthesiologyUCLALos AngelesCaliforniaUSA
| | - Douglas G. Ririe
- Department of AnesthesiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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11
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Brodosi L, Petta S, Petroni ML, Marchesini G, Morelli MC. Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients. Transplantation 2022; 106:462-478. [PMID: 34172646 PMCID: PMC9904447 DOI: 10.1097/tp.0000000000003867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clinical outcomes; careful monitoring and appropriate treatment are pivotal to reduce cardiovascular events and graft and recipients' death. We thoroughly reviewed the epidemiology of diabetes in the transplant setting and the different therapeutic options, from lifestyle intervention to antidiabetic drug use-including the most recent drug classes available-and to the inclusion of bariatric surgery in the treatment cascade. In waitlisted patients, the old paradigm that insulin should be the treatment of choice in the presence of severe liver dysfunction is no longer valid; novel antidiabetic agents may provide adequate glucose control without the risk of hypoglycemia, also offering cardiovascular protection. The same evidence applies to the posttransplant phase, where oral or injectable noninsulin agents should be considered to treat patients to target, limiting the impact of disease on daily living, without interaction with immunosuppressive regimens. The increasing prevalence of liver disease of metabolic origin (nonalcoholic fatty liver) among liver transplant candidates, also having a higher risk of noncirrhotic hepatocellular cancer, is likely to accelerate the acceptance of new drugs and invasive procedures, as suggested by international guidelines. Intensive lifestyle intervention programs remain however mandatory, both before and after transplantation. Achievement of adequate control is mandatory to increase candidacy, to prevent delisting, and to improve long-term outcomes.
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Affiliation(s)
- Lucia Brodosi
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Maria L. Petroni
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Giulio Marchesini
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Maria C. Morelli
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Abstract
Sex and gender often are used interchangeably, but are two distinct entities, with sex being the biological attribute and gender including the social, psychological, and cultural aspects of one's identity. Kidney transplantation has been proven to be the best treatment for end-stage kidney disease, improving both quality of life and life-expectancy for most patients. However, gender disparities in access to and outcomes of kidney transplantation remain despite the plethora of evidence showing the advantages of kidney transplantation to our patients. Data have shown that women are less likely to be waitlisted for a kidney transplant and to receive a deceased donor or a living donor kidney. On the other hand, women are more likely than men to become living kidney donors. Although some state the latter is the result of the female gender to nurture and care for loved ones, others believe this observation is because women often are incompatible with their spouse or child because pregnancy is a strong sensitizing event, which stems from the biological rather than the social differences between the sexes. Influence of sex and gender is not limited to access to kidney transplantation, but rather exist in other areas of transplant medicine, such as the difference observed in transplant outcomes between the sexes, variability in immunosuppression metabolism, and even in more contemporary areas such as recent data showing sex-based differences in outcomes of kidney transplant recipients with coronavirus disease-2019, with males having an increased incidence of acute kidney injury and death.
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Affiliation(s)
- Goni Katz-Greenberg
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Silvi Shah
- Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH.
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13
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Salamone IM, Quattrocelli M, Barefield DY, Page PG, Tahtah I, Hadhazy M, Tomar G, McNally EM. Intermittent glucocorticoid treatment enhances skeletal muscle performance through sexually dimorphic mechanisms. J Clin Invest 2022; 132:149828. [PMID: 35143417 PMCID: PMC8920338 DOI: 10.1172/jci149828] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Glucocorticoid steroids are commonly prescribed for many inflammatory conditions, but chronic daily use produces adverse effects, including muscle wasting and weakness. In contrast, shorter glucocorticoid pulses may improve athletic performance, although the mechanisms remain unclear. Muscle is sexually dimorphic and comparatively little is known about how male and female muscles respond to glucocorticoids. We investigated the impact of once-weekly glucocorticoid exposure on skeletal muscle performance comparing male and female mice. One month of once-weekly glucocorticoid dosing improved muscle specific force in both males and females. Transcriptomic profiling of isolated myofibers identified a striking sexually dimorphic response to weekly glucocorticoids. Male myofibers had increased expression of genes in the IGF1/PI3K pathway and calcium handling, while female myofibers had profound upregulation of lipid metabolism genes. Muscles from weekly prednisone–treated males had improved calcium handling, while comparably treated female muscles had reduced intramuscular triglycerides. Consistent with altered lipid metabolism, weekly prednisone–treated female mice had greater endurance relative to controls. Using chromatin immunoprecipitation, we defined a sexually dimorphic chromatin landscape after weekly prednisone. These results demonstrate that weekly glucocorticoid exposure elicits distinct pathways in males versus females, resulting in enhanced performance.
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Affiliation(s)
- Isabella M Salamone
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Mattia Quattrocelli
- Department of Pediatrics, Cinicinnati Children's Hospital, Cincinnati, United States of America
| | - David Y Barefield
- Cell and Molecular Physiology, Loyola University Stritch School of Medicine, Maywood, United States of America
| | - Patrick G Page
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Ibrahim Tahtah
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Michele Hadhazy
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Garima Tomar
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States of America
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14
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Sex-related differences in the efficacy of immune checkpoint inhibitors in malignancy: a systematic review and meta-analysis. Aging (Albany NY) 2021; 13:15413-15432. [PMID: 34086601 PMCID: PMC8221333 DOI: 10.18632/aging.203100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Although disease susceptibility is known to differ between men and women, it is controversial whether the efficacy of immune checkpoint inhibitors for malignancies also differs between the sexes. We conducted a meta-analysis to explore the impact of sex on immune checkpoint inhibitor treatment outcomes. We searched PubMed, Embase and the Cochrane Library databases from inception to October 1, 2020 for randomized controlled trials of immune checkpoint inhibitors with hazard ratios (HRs) stratified by sex. We calculated the pooled HRs for men and women using the ln(HR), and assessed the heterogeneity between the two estimates through an interaction test. In total, 22,268 patients from 39 randomized controlled trials were included. Immune checkpoint inhibitors yielded better overall survival than conventional agents in both men (HR: 0.75, 95% confidence interval [CI]: 0.71-0.80) and women (HR: 0.77, 95% CI: 0.70-0.85). Progression-free survival benefits were also observed in both men (HR: 0.64, 95% CI: 0.58-0.70) and women (HR: 0.67, 95% CI: 0.58-0.77) treated with immune checkpoint inhibitors. No sex differences in the response to immune checkpoint inhibitors were found when overall survival and progression-free survival were used as the endpoints.
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15
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Population pharmacodynamic modeling of intramuscular and oral dexamethasone and betamethasone effects on six biomarkers with circadian complexities in Indian women. J Pharmacokinet Pharmacodyn 2021; 48:411-438. [PMID: 33954911 PMCID: PMC8099395 DOI: 10.1007/s10928-021-09755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/03/2021] [Indexed: 11/07/2022]
Abstract
Population pharmacokinetic/pharmacodynamic (PK/PD) analysis was performed for extensive data for differing dosage forms and routes for dexamethasone (DEX) and betamethasone (BET) in 48 healthy nonpregnant Indian women in a partial and complex cross-over design. Single doses of 6 mg dexamethasone phosphate (DEX-P), betamethasone phosphate (BET-P), or 1:1 mixture of betamethasone phosphate and acetate (BET-PA) were administered orally (PO) or intramuscularly (IM) where each woman enrolled in a two-period cross-over study. Plasma concentrations collected over 96 h were described with a two-compartment model with differing PO and IM first-order absorption inputs. Overall, BET exhibited slower clearance, similar volume of distribution, faster absorption, and longer persistence than DEX with BET acetate producing extremely slow absorption but full bioavailability of BET. Six biomarkers were assessed over a 24-h baseline period with four showing circadian rhythms with complex baselines. These baselines and the strong responses seen after drug dosing were fitted with various indirect response models using the Laplace estimation methods in NONMEM 7.4. Both the PK and six biomarker responses were well-described with modest variability likely due to the homogeneous ages, weights, and ethnicities of the women. The drugs either inhibited or stimulated the influx processes with some models requiring joint inclusion of drug effects on circadian cortisol suppression. The biomarkers and order of sensitivity (lowest IC50/SC50 to highest) were: cortisol, T-helper cells, basophils, glucose, neutrophils, and T-cytotoxic cells. DEX sensitivities were generally greater than BET with corresponding mean ratios for these biomarkers of 2.86, 1.27, 1.72, 1.27, 2.69, and 1.06. Overall, the longer PK (e.g. half-life) of BET, but lesser PD activity (e.g. higher IC50), produces single-dose response profiles that appear quite similar, except for the extended effects from BET-PA. This comprehensive population modeling effort provides the first detailed comparison of the PK profiles and six biomarker responses of five commonly used dosage forms of DEX and BET in healthy women.
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16
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Minguito-Carazo C, Gómez-Bueno M, Almenar-Bonet L, Barge-Caballero E, González-Vílchez F, Delgado-Jiménez JF, María Arizón Del Prado J, Sousa-Casasnovas I, Mirabet-Pérez S, González-Costello J, Sobrino-Márquez JM, Pérez-Villa F, Díaz-Molina B, Rábago Juan-Aracil G, Blasco-Peiró T, De la Fuente Galán L, Garrido-Bravo I, García-Guereta L, Camino M, Albert-Brotons DC, Muñiz J, Crespo-Leiro MG. Malignancy following heart transplantation: differences in incidence and prognosis between sexes - a multicenter cohort study. Transpl Int 2021; 34:882-893. [PMID: 33482021 DOI: 10.1111/tri.13827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022]
Abstract
Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.
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Affiliation(s)
| | - Manuel Gómez-Bueno
- Heart Failure, Heart Transplant and Pulmonary Hypertension Unit, University Hospital of Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar-Bonet
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department of Complexo Hospitalario Universitario de A Coruña (CHUAC) Sergas, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Francisco González-Vílchez
- Advanced Heart Failure and Transplant Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan F Delgado-Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of University Hospital 12 de Octubre, Facultad de Medicina UCM, Madrid, Spain
| | - José María Arizón Del Prado
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Iago Sousa-Casasnovas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sónia Mirabet-Pérez
- Heart Failure and Transplant Unit, Cardiology Department of Hospital de Sant Pau, Barcelona, Spain
| | | | - José Manuel Sobrino-Márquez
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Félix Pérez-Villa
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Clínic, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Teresa Blasco-Peiró
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis De la Fuente Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Iris Garrido-Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis García-Guereta
- Pediatric Heart Transplant Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Manuela Camino
- Pediatric Heart Transplant Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Universidade da Coruña (UDC), Instituto Universitario de Ciencias de la Salud, A Coruña, Spain
| | - Maria G Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department of Complexo Hospitalario Universitario de A Coruña (CHUAC) Sergas, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Universidade da Coruña (UDC), Instituto Universitario de Ciencias de la Salud, A Coruña, Spain
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17
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Li X, Zhang H, Li C, Zheng W, Wang M, Wu M, Yang D, Hu Y, Huo D, Xu Z, Ding Y, Liu L. Comparison of the Pharmacokinetics of Generic Versus Branded Obeticholic Acid in a Chinese Population: Effects of Food and Sex. Clin Pharmacol Drug Dev 2021; 10:797-806. [PMID: 33463088 DOI: 10.1002/cpdd.905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/09/2020] [Indexed: 11/07/2022]
Abstract
The present study assessed the pharmacokinetics and bioequivalence of a single 10-mg dose of a generic and the branded formulation (Ocaliva) of obeticholic acid (OCA) in healthy Chinese subjects under fasting and fed conditions. The possible effects of food and sex on the pharmacokinetics of OCA and its 2 active metabolites (glyco-OCA and tauro-OCA) were evaluated. Plasma concentrations of OCA and its 2 active metabolites were measured by liquid chromatography-tandem mass spectrometry. The 90%CIs of the ratios of the test and reference formulations for Cmax , AUC0-t , and AUC0-∞ of OCA, glyco-OCA, and tauro-OCA were contained entirely within the 80% to 125% range required for bioequivalence under fasting and fed conditions. Plasma exposure of OCA was 30% to 36% higher under fed compared with fasting conditions. Plasma exposure of OCA, glyco-OCA, and tauro-OCA was 39% to 66%, 22% to 58%, and 37% to 84% higher, respectively, in women compared with men under fasting and fed conditions. In conclusion, OCA was well tolerated in healthy Chinese subjects under fasting and fed conditions. The single 10-mg dose of a generic OCA formulation was bioequivalent to Ocaliva. Food and sex impacted the pharmacokinetics of OCA and/or its 2 active metabolites. Further studies are required to determine if these effects are clinically relevant.
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Affiliation(s)
- Xiaojiao Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Hong Zhang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Cuiyun Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Wenbo Zheng
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Meng Wang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Min Wu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Deming Yang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Yue Hu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Dandan Huo
- Chia Tai Tianqing Pharmaceutical Group Co. Ltd, Jiangsu, China
| | - Zhongnan Xu
- Chia Tai Tianqing Pharmaceutical Group Co. Ltd, Jiangsu, China
| | - Yanhua Ding
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Li Liu
- Department of Pediatrics, First Hospital, Jilin University, Jilin, China
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18
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Ayyar VS, Jusko WJ. Transitioning from Basic toward Systems Pharmacodynamic Models: Lessons from Corticosteroids. Pharmacol Rev 2020; 72:414-438. [PMID: 32123034 DOI: 10.1124/pr.119.018101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Technology in bioanalysis, -omics, and computation have evolved over the past half century to allow for comprehensive assessments of the molecular to whole body pharmacology of diverse corticosteroids. Such studies have advanced pharmacokinetic and pharmacodynamic (PK/PD) concepts and models that often generalize across various classes of drugs. These models encompass the "pillars" of pharmacology, namely PK and target drug exposure, the mass-law interactions of drugs with receptors/targets, and the consequent turnover and homeostatic control of genes, biomarkers, physiologic responses, and disease symptoms. Pharmacokinetic methodology utilizes noncompartmental, compartmental, reversible, physiologic [full physiologically based pharmacokinetic (PBPK) and minimal PBPK], and target-mediated drug disposition models using a growing array of pharmacometric considerations and software. Basic PK/PD models have emerged (simple direct, biophase, slow receptor binding, indirect response, irreversible, turnover with inactivation, and transduction models) that place emphasis on parsimony, are mechanistic in nature, and serve as highly useful "top-down" methods of quantitating the actions of diverse drugs. These are often components of more complex quantitative systems pharmacology (QSP) models that explain the array of responses to various drugs, including corticosteroids. Progressively deeper mechanistic appreciation of PBPK, drug-target interactions, and systems physiology from the molecular (genomic, proteomic, metabolomic) to cellular to whole body levels provides the foundation for enhanced PK/PD to comprehensive QSP models. Our research based on cell, animal, clinical, and theoretical studies with corticosteroids have provided ideas and quantitative methods that have broadly advanced the fields of PK/PD and QSP modeling and illustrates the transition toward a global, systems understanding of actions of diverse drugs. SIGNIFICANCE STATEMENT: Over the past half century, pharmacokinetics (PK) and pharmacokinetics/pharmacodynamics (PK/PD) have evolved to provide an array of mechanism-based models that help quantitate the disposition and actions of most drugs. We describe how many basic PK and PK/PD model components were identified and often applied to the diverse properties of corticosteroids (CS). The CS have complications in disposition and a wide array of simple receptor-to complex gene-mediated actions in multiple organs. Continued assessments of such complexities have offered opportunities to develop models ranging from simple PK to enhanced PK/PD to quantitative systems pharmacology (QSP) that help explain therapeutic and adverse CS effects. Concurrent development of state-of-the-art PK, PK/PD, and QSP models are described alongside experimental studies that revealed diverse CS actions.
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Affiliation(s)
- Vivaswath S Ayyar
- Department of Pharmaceutical Sciences University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - William J Jusko
- Department of Pharmaceutical Sciences University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
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19
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Almquist J, Sadiq MW, Eriksson UG, Hegelund Myrbäck T, Prothon S, Leander J. Estimation of Equipotent Doses for Anti-Inflammatory Effects of Prednisolone and AZD9567, an Oral Selective Nonsteroidal Glucocorticoid Receptor Modulator. CPT Pharmacometrics Syst Pharmacol 2020; 9:444-455. [PMID: 32501650 PMCID: PMC7438818 DOI: 10.1002/psp4.12536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
AZD9567 is a potent and selective nonsteroidal oral glucocorticoid receptor modulator. It is developed as an anti-inflammatory drug with improved safety profile compared with steroids like prednisolone. Throughout the clinical development of AZD9567, dose selection and data interpretation require a method for determining doses with the same anti-inflammatory effect as prednisolone. Equipotent doses of AZD9567 and prednisolone were defined by the same average inhibition of TNFα release, a biomarker of anti-inflammatory effect, measured in a lipopolysaccharide-stimulated whole blood ex vivo assay. Based on pharmacokinetic-pharmacodynamic models, TNFα dose-response relationships for AZD9567 and prednisolone were established. A comparison of the dose-response curves enabled estimation of an equipotency relationship. Specifically, 20 mg prednisolone was estimated to be equipotent to 40 mg AZD9567 (95% confidence interval: 29-54 mg). Static concentration-response analyses showed that the relative potencies for inhibition of TNFα release of AZD9567 and prednisolone were well aligned with several other pro-inflammatory cytokines.
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Affiliation(s)
- Joachim Almquist
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
| | - Muhammad Waqas Sadiq
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
| | - Ulf G. Eriksson
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
| | - Tove Hegelund Myrbäck
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
| | - Susanne Prothon
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
| | - Jacob Leander
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety SciencesR&D, AstraZenecaGothenburgSweden
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20
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Ikeda T, Fujiwara SI, Nakajima HI, Kawaguchi SI, Toda Y, Ito S, Ochi S, Nagayama T, Mashima K, Umino K, Minakata D, Nakano H, Morita K, Yamasaki R, Kawasaki Y, Ashizawa M, Yamamoto C, Hatano K, Sato K, Oh I, Ohmine K, Muroi K, Kanda Y. Impact of prednisolone dosage in the CHOP regimen for follicular lymphoma: a retrospective study. Int J Hematol 2020; 112:369-376. [PMID: 32529585 DOI: 10.1007/s12185-020-02908-8] [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: 01/06/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) is one of the standard regimens for indolent B-cell non-Hodgkin's lymphoma (NHL). It is unclear whether the prednisolone (PSL) dosage affects the therapeutic effect or the adverse event profile. We retrospectively examined 48 patients with indolent B-cell NHL who were treated with R-CHOP (PSL 50 mg/m2/day for 5 days) at our institute between 2006 and 2016. We compared them with 149 patients with indolent B-cell lymphoma who were treated with R-CHOP (PSL 100 mg for 5 days) in the JCOG 0203 trial. The proportions of patients with bulky disease, extranodal involvement, and increased nodal sites were higher at our institute. Nevertheless, there was no difference in the CR rate, PFS, OS or the frequency of adverse events, except for peripheral neuropathy, between the two treatment groups. In our institute, there was no difference in the CR rate, PFS, OS or adverse event profile between patients who received PSL at 60-80 mg/day and at 81-100 mg/day. Patients who received PSL at 60-80 mg/day included many female and light-weight patients. In conclusion, the PSL dose adjusted based on body surface area appeared to be appropriate in terms of efficacy and safety.
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Affiliation(s)
- Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - HIrotomo Nakajima
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Shinichi Ochi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kiyomi Mashima
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Yasufumi Kawasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Iekuni Oh
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Kazuo Muroi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
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21
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Mayumi K, Akazawa T, Kanazu T, Ohnishi S, Hasegawa H. Successful Prediction of Human Pharmacokinetics After Oral Administration by Optimized Physiologically Based Pharmacokinetics Approach and Permeation Assay Using Human Induced Pluripotent Stem Cell–Derived Intestinal Epithelial Cells. J Pharm Sci 2020; 109:1605-1614. [DOI: 10.1016/j.xphs.2019.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/29/2022]
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22
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Dias SP, Brouwer MC, van de Beek D. Sex-based differences in the response to dexamethasone in bacterial meningitis: Analysis of the European dexamethasone in adulthood bacterial meningitis study. Br J Clin Pharmacol 2020; 86:386-391. [PMID: 31692016 PMCID: PMC7015757 DOI: 10.1111/bcp.14163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/28/2019] [Accepted: 10/13/2019] [Indexed: 01/25/2023] Open
Abstract
Inflammatory markers have been found at higher concentrations in women than men with bacterial meningitis. To investigate sex‐based differences in the response to dexamethasone, we performed a post hoc analysis of a double‐blind, randomised multicentre trial of dexamethasone (10 mg, 4 times daily for 4 days) vs placebo in adults with bacterial meningitis. The primary outcome measure was the Glasgow outcome scale score at 8 weeks and interaction tests were used to examine subgroup differences. Between June 1993 and December 2001, 301 patients (56% male) were randomly assigned to a treatment group: 157 received dexamethasone and 144 placebo. Although dexamethasone reduced the risk of unfavourable outcome to a greater extent in women (relative risk [RR] 0.42, 95% confidence interval [CI] 0.21–0.86, P = .02) than men (RR 0.79, 95% CI 0.41–1.51, P = .55), on interaction testing (ratio of RR women:men 0.53, 95% CI 0.20–1.39, P = .19) patient sex was not a significant modifier of the effect of dexamethasone.
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Affiliation(s)
- Sara P Dias
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Scherholz ML, Rao RT, Androulakis IP. Modeling inter-sex and inter-individual variability in response to chronopharmacological administration of synthetic glucocorticoids. Chronobiol Int 2019; 37:281-296. [PMID: 31797700 DOI: 10.1080/07420528.2019.1660357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endogenous glucocorticoids have diverse physiological effects and are important regulators of metabolism, immunity, cardiovascular function, musculoskeletal health and central nervous system activity. Synthetic glucocorticoids have received widespread attention for their potent anti-inflammatory activity and have become an important class of drugs used to augment endogenous glucocorticoid activity for the treatment of a host of chronic inflammatory conditions. Chronic use of synthetic glucocorticoids is associated with a number of adverse effects as a result of the persistent dysregulation of glucocorticoid sensitive pathways. A failure to consider the pronounced circadian rhythmicity of endogenous glucocorticoids can result in either supraphysiological glucocorticoid exposure or severe suppression of endogenous glucocorticoid secretion, and is thought be a causal factor in the incidence of adverse effects during chronic glucocorticoid therapy. Furthermore, given that synthetic glucocorticoids have potent feedback effects on the hypothalamic-pituitary-adrenal (HPA) axis, physiological factors which can give rise to individual variability in HPA axis activity such as sex, age, and disease state might also have substantial implications for therapy. We use a semi-mechanistic mathematical model of the rodent HPA axis to study how putative sex differences and individual variability in HPA axis regulation can influence the effects of long-term synthetic exposure on endogenous glucocorticoid circadian rhythms. Model simulations suggest that for the same drug exposure, simulated females exhibit less endogenous suppression than males considering differences in adrenal sensitivity and negative feedback to the hypothalamus and pituitary. Simulations reveal that homeostatic regulatory variability and chronic stress-induced regulatory adaptations in the HPA axis network can result in substantial differences in the effects of synthetic exposure on the circadian rhythm of endogenous glucocorticoids. In general, our results provide insight into how the dosage and exposure profile of synthetic glucocorticoids could be manipulated in a personalized manner to preserve the circadian dynamics of endogenous glucocorticoids during chronic therapy, thus potentially minimizing the incidence of adverse effects associated with long-term use of glucocorticoids.
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Affiliation(s)
- Megerle L Scherholz
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Rohit T Rao
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Ioannis P Androulakis
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ.,Department of Biomedical Engineering, Rutgers The State University of New Jersey, Piscataway, NJ.,Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brusnwick, NJ
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Scherholz ML, Schlesinger N, Androulakis IP. Chronopharmacology of glucocorticoids. Adv Drug Deliv Rev 2019; 151-152:245-261. [PMID: 30797955 DOI: 10.1016/j.addr.2019.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/24/2018] [Accepted: 02/13/2019] [Indexed: 12/30/2022]
Abstract
Glucocorticoids influence a wide array of metabolic, anti-inflammatory, immunosuppressive, and cognitive signaling processes, playing an important role in homeostasis and preservation of normal organ function. Synthesis is regulated by the hypothalamic-pituitary-adrenal (HPA) axis of which cortisol is the primary glucocorticoid in humans. Synthetic glucocorticoids are important pharmacological agents that augment the anti-inflammatory and immunosuppressive properties of endogenous cortisol and are widely used for the treatment of asthma, Crohn's disease, and rheumatoid arthritis, amongst other chronic conditions. The homeostatic activity of cortisol is disrupted by the administration of synthetic glucocorticoids and so there is interest in developing treatment options that minimize HPA axis disturbance while maintaining the pharmacological effects. Studies suggest that optimizing drug administration time can achieve this goal. The present review provides an overview of endogenous glucocorticoid activity and recent advances in treatment options that have further improved patient safety and efficacy with an emphasis on chronopharmacology.
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Mangin O, Zheng Y, Bouazza N, Foissac F, Benaboud S, Lui G, Hirt D, Mouthon L, Tréluyer JM, Urien S. Free prednisolone pharmacokinetics predicted from total concentrations in patients with inflammatory - immunonologic conditions. Fundam Clin Pharmacol 2019; 34:270-278. [PMID: 31625621 DOI: 10.1111/fcp.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/25/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Abstract
Prednisone is an anti-inflammatory drug widely used in internal medicine and rheumatology, but dosing remains empirical. The active metabolite of prednisone is free prednisolone. The aim of this work was to build a population pharmacokinetic (PK) model that can predict free prednisolone concentrations in patients with inflammatory/immunologic conditions.A total of 107 patients from the department of internal medicine of Cochin hospital provided 343 observations. Blood samples drawn for biological analyses were used for drug determination. Total plasma prednisolone concentrations were measured by liquid chromatography-mass spectrometry, and the data were modelled using Monolix. The pharmacokinetics was ascribed a one-compartment open model with three transit compartments standing for the absorption and metabolism process. The model used predicts free concentrations that served to derive total concentrations given published binding constants. Only size parameters influenced the pharmacokinetics. Free prednisolone CLU /F and VU /F, scaled allometrically on lean body weight, were, respectively, 26.7 L/h and 94.3 L for 50 kg LBW. CLU /F interindividual variability was 0.20. The additive and proportional residual variabilities were, respectively, 4.3 µg/L and 0.20. The results point out some dosing issues, that is the possibility of under- or over-dosage in thin or overweight patients respectively.
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Affiliation(s)
- Olivier Mangin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Yi Zheng
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Naïm Bouazza
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Pariss, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Frantz Foissac
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Pariss, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Sihem Benaboud
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Gabrielle Lui
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Déborah Hirt
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Marc Tréluyer
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France.,Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Pariss, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
| | - Saïk Urien
- Sorbonne Paris Cité, Université Paris Descartes, EA7323, Paris, France.,Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Pariss, France.,Cochin-Necker, CIC-1419 Inserm, Paris, France
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26
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Sex and the kidneys: current understanding and research opportunities. Nat Rev Nephrol 2019; 15:776-783. [PMID: 31586165 DOI: 10.1038/s41581-019-0208-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
Abstract
Concerns regarding sex differences are increasingly pertinent in scientific and societal arenas. Although biological sex and socio-cultural gender are increasingly recognized as important modulators of renal function under physiological and pathophysiological conditions, gaps remain in our understanding of the mechanisms underlying sex differences in renal pathophysiology, disease development, progression and management. In this Perspectives article, we discuss specific opportunities for future research aimed at addressing these knowledge gaps. Such opportunities include the development of standardized core data elements and outcomes related to sex for use in clinical studies to establish a connection between sex hormones and renal disease development or progression, development of a knowledge portal to promote fundamental understanding of physiological differences between male and female kidneys in animal models and in humans, and the creation of new or the development of existing resources and datasets to make them more readily available for interrogation of sex differences. These ideas are intended to stimulate thought and interest among the renal research community as they consider sex as a biological variable in future research projects.
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Schmid Y, Navarini A, Thomas ZRM, Pfleiderer B, Krähenbühl S, Mueller SM. Sex differences in the pharmacology of itch therapies-a narrative review. Curr Opin Pharmacol 2019; 46:122-142. [PMID: 31299512 DOI: 10.1016/j.coph.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic itch is the most common skin-related condition, associated with a high psychosocial and economic burden. In recent years, increasing evidence of sex differences in the perception, clinical presentation and treatment requirements of itch points towards potential benefits when using sex-adapted therapies. It is well-known that body composition, absorption, metabolism, elimination and adverse drug reactions (ADRs) differ between sexes, but only little is known about the impact of sex in the pharmacology of itch treatments, which could help to rationalise sex-adapted treatment strategies. AIM To evaluate and review sex effects in the pharmacokinetics and /-dynamics of drugs used to treat itch. METHODS In this narrative review we performed a PubMed and MEDLINE (Ovid) search using the terms (itch OR pruritus) AND (gender OR sex) AND (drug OR medication OR pharmacokinetics OR pharmacodynamics). Additional searches were performed for the topical and systemic drugs recommended by the European Guideline on Chronic Pruritus. RESULTS We found numerous reports with variable levels of evidence of sex effects with respect to the pharmacokinetics and/or pharmacodynamics of 14 drug classes used for the treatment of itch, including a total of 19 systemic and 3 topical drugs. Women seem to present higher plasma levels of several drugs used in itch treatment, including tri- and tetracyclic antidepressants (e.g. doxepin, amitriptyline, mirtazapine), serotonin reuptake inhibitors (e.g. paroxetine, sertraline, fluoxetine), immunosuppressive drugs (e.g. cyclosporine, mycophenolate mofetil), serotonin receptor antagonists (e.g. ondansetron) and betablockers (e.g. propranolol). Adverse drug reactions (ADRs) were generally more common in women. Being female was reported to be an independent risk factor for QTc-prolongation associated with antihistamines and tetracyclic antidepressants. Additionally, women seem to be more prone to sedative effects of antihistamines, and to suffer from a higher frequency as well as severity of side effects with systemic calcineurin inhibitors, opioid agonists, and opioid antagonists. Women were also sensitised more often to topically applied drugs. Of note, apart from only one experimental study with capsaicin, none of these reports were designed specifically to assess the effect of sex (and gender) in the treatment of itch. DISCUSSION/CONCLUSION Our review supports previous reports that sex is of importance in the pharmacokinetics and /-dynamics of several drugs used to treat itch although those drugs were mostly evaluated for non-itch indications. However, the results are limited by methodological limitations evident in most studies such as underrepresentation of women in clinical trials. This emphasises the need to study the impact of sex (and gender) in future itch trials to yield better outcomes and prevent ADRs in both sexes.
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Affiliation(s)
- Yasmin Schmid
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | | | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University Hospital Münster and Medical Faculty, University of Münster, Germany; Competence Center Chronic Pruritus (KCP), University of Muenster, Germany
| | - Stephan Krähenbühl
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Switzerland.
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28
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Cansu GB, Cansu DÜ, Taşkıran B, Bilge ŞY, Bilgin M, Korkmaz C. What is the optimal time for measuring glucose concentration to detect steroid-induced hyperglycemia in patients with rheumatic diseases? Clin Biochem 2019; 67:33-39. [DOI: 10.1016/j.clinbiochem.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 01/09/2023]
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29
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Violatto MB, Casarin E, Talamini L, Russo L, Baldan S, Tondello C, Messmer M, Hintermann E, Rossi A, Passoni A, Bagnati R, Biffi S, Toffanin C, Gimondi S, Fumagalli S, De Simoni MG, Barisani D, Salmona M, Christen U, Invernizzi P, Bigini P, Morpurgo M. Dexamethasone Conjugation to Biodegradable Avidin-Nucleic-Acid-Nano-Assemblies Promotes Selective Liver Targeting and Improves Therapeutic Efficacy in an Autoimmune Hepatitis Murine Model. ACS NANO 2019; 13:4410-4423. [PMID: 30883091 DOI: 10.1021/acsnano.8b09655] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Steroids are the standard therapy for autoimmune hepatitis (AIH) but the long-lasting administration is hampered by severe side effects. Methods to improve the tropism of the drug toward the liver are therefore required. Among them, conjugation to nanoparticles represents one possible strategy. In this study, we exploited the natural liver tropism of Avidin-Nucleic-Acid-Nano-Assemblies (ANANAS) to carry dexamethasone selectively to the liver in an AIH animal model. An acid-labile biotin-hydrazone linker was developed for reversible dexamethasone loading onto ANANAS. The biodistribution, pharmacokinetics and efficacy of free and ANANAS-linked dexamethasone (ANANAS-Hz-Dex) in healthy and AIH mice were investigated upon intraperitoneal administration. In ANANAS-treated animals, the free drug was detected only in the liver. Super-resolution microscopy showed that nanoparticles segregate inside lysosomes of liver immunocompetent cells, mainly involved in AIH progression. In agreement with these observational results, chronic low-dose treatment with ANANAS-Hz-Dex reduced the expression of liver inflammation markers and, in contrast to the free drug, also the levels of circulating AIH-specific autoantibodies. These data suggest that the ANANAS carrier attenuates AIH-related liver damage without drug accumulation in off-site tissues. The safety and biodegradability of the ANANAS carrier make this formulation a promising tool for the treatment of autoimmune liver disorders.
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Affiliation(s)
- Martina Bruna Violatto
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | | | - Laura Talamini
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Luca Russo
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Simone Baldan
- Department of Pharmaceutical and Pharmacological Sciences , University of Padova , Padova , 35131 , Italy
| | - Camilla Tondello
- Department of Pharmaceutical and Pharmacological Sciences , University of Padova , Padova , 35131 , Italy
| | - Marie Messmer
- Pharmazentrum Frankfurt/ZAFES , Goethe University Hospital Frankfurt , Frankfurt am Main , 60488 , Germany
| | - Edith Hintermann
- Pharmazentrum Frankfurt/ZAFES , Goethe University Hospital Frankfurt , Frankfurt am Main , 60488 , Germany
| | - Alessandro Rossi
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Alice Passoni
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Renzo Bagnati
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Stefania Biffi
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo″ , Trieste , 34137 , Italy
| | - Chiara Toffanin
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Sara Gimondi
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Stefano Fumagalli
- Department of Neuroscience, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Maria-Grazia De Simoni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Donatella Barisani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, 20900, Italy
| | - Mario Salmona
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Urs Christen
- Pharmazentrum Frankfurt/ZAFES , Goethe University Hospital Frankfurt , Frankfurt am Main , 60488 , Germany
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, 20900, Italy
| | - Paolo Bigini
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, 20156, Italy
| | - Margherita Morpurgo
- Department of Pharmaceutical and Pharmacological Sciences , University of Padova , Padova , 35131 , Italy
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Changes in the Canine Plasma Lipidome after Short- and Long-Term Excess Glucocorticoid Exposure. Sci Rep 2019; 9:6015. [PMID: 30979907 PMCID: PMC6461633 DOI: 10.1038/s41598-019-42190-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023] Open
Abstract
Glucocorticoids (GCs) are critical regulators of metabolic control in mammals and their aberrant function has been linked to several pathologies. GCs are widely used in human and veterinary clinical practice as potent anti-inflammatory and immune suppressive agents. Dyslipidaemia is a frequently observed consequence of GC treatment, typified by increased lipolysis, lipid mobilization, liponeogenesis, and adipogenesis. Dogs with excess GC show hyperlipidaemia, hypertension, and a higher risk of developing type 2 diabetes mellitus, but the risk of developing atherosclerotic lesions is low as compared to humans. This study aimed to examine alterations in the canine plasma lipidome in a model of experimentally induced short-term and long-term GC excess. Both treatments led to significant plasma lipidome alterations, which were more pronounced after long-term excess steroid exposure. In particular, monohexosylceramides, phosphatidylinositols, ether phosphatidylcholines, acyl phosphatidylcholines, triacylglycerols and sphingosine 1-phosphates showed significant changes. The present study highlights the hitherto unknown effects of GCs on lipid metabolism, which will be important in the further elucidation of the role and function of GCs as drugs and in metabolic and cardiovascular diseases.
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31
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Deng J, Chalhoub NE, Sherwin CM, Li C, Brunner HI. Glucocorticoids pharmacology and their application in the treatment of childhood-onset systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49:251-259. [PMID: 30987856 DOI: 10.1016/j.semarthrit.2019.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
Glucocorticoids are potent anti-inflammatory and immunosuppressant medications and remain the mainstay of systemic lupus erythematosus (SLE) therapy. The potency of a specific glucocorticoid, i.e., the dose of glucocorticoid that is required to produce a specific effect, is dependent on its pharmacokinetic (PK) and pharmacodynamic (PD) properties. In this review, we summarize the PK/PD properties of commonly used glucocorticoids in an attempt to better delineate their role in the management of children with childhood-onset SLE (cSLE). We also address glucocorticoid side effects as these play a major role when deciding on the dose, frequency, and duration of use. A better understanding of the pharmacology of glucocorticoids appears useful to achieve improved outcomes in the management of cSLE.
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Affiliation(s)
- Jianghong Deng
- Department of Rheumatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China; Division of Rheumatology, Cincinnati Children's Hospital Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Nathalie E Chalhoub
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine M Sherwin
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Caifeng Li
- Department of Rheumatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China.
| | - Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Mavroudis PD, van den Anker J, Conklin LS, Damsker JM, Hoffman EP, Nagaraju K, Clemens PR, Jusko WJ. Population Pharmacokinetics of Vamorolone (VBP15) in Healthy Men and Boys With Duchenne Muscular Dystrophy. J Clin Pharmacol 2019; 59:979-988. [PMID: 30742306 DOI: 10.1002/jcph.1388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/18/2019] [Indexed: 02/06/2023]
Abstract
Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder occurring in boys and caused by mutations in the dystrophin gene. Vamorolone is a first-generation delta-9,11 compound that has favorable efficacy and side effect profiles relative to classical glucocorticoids. The pharmacokinetics (PK) of oral vamorolone were assessed in parallel-group studies in healthy men (phase 1, n = 86) and boys with DMD (phase 2a, n = 48) during 14 days of once-daily dosing with a range of doses. Vamorolone exhibited moderate variability in PK, with the maximum plasma concentration usually occurring at 2-4 hours and a half-life of approximately 2 hours for all doses and days examined. Population PK modeling of all data together indicated that the PK of vamorolone can be well described by a 1-compartment model with zero-order absorption. Both men and boys showed a dose-linearity of PK parameters for the doses examined, with no accumulation of the drug during daily dosing. Ingestion with food resulted in markedly enhanced absorption of the drug, as tested in healthy men. There were similar PK of vamorolone in healthy men and DMD boys with apparent clearance averaging 2.0 L/h/kg in men and 1.7 L/h/kg in boys. Overall, vamorolone exhibited well-behaved linear PK, with similar profiles in healthy men and boys with DMD, moderate variability in PK parameters, and absorption and disposition profiles similar to those of classical glucocorticoids.
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Affiliation(s)
- Panteleimon D Mavroudis
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - John van den Anker
- ReveraGen Biopharma, Rockville, MD, USA.,Children's National Health System, Washington, DC, USA
| | - Laurie S Conklin
- ReveraGen Biopharma, Rockville, MD, USA.,Children's National Health System, Washington, DC, USA
| | | | - Eric P Hoffman
- ReveraGen Biopharma, Rockville, MD, USA.,Binghamton University-SUNY, Binghamton, NY, USA
| | - Kanneboyina Nagaraju
- ReveraGen Biopharma, Rockville, MD, USA.,Binghamton University-SUNY, Binghamton, NY, USA
| | - Paula R Clemens
- University of Pittsburgh and Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - William J Jusko
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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33
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Negera E, Tilahun M, Bobosha K, Lambert SM, Walker SL, Spencer JS, Aseffa A, Dockrell HM, Lockwood DN. The effects of prednisolone treatment on serological responses and lipid profiles in Ethiopian leprosy patients with Erythema Nodosum Leprosum reactions. PLoS Negl Trop Dis 2018; 12:e0007035. [PMID: 30592714 PMCID: PMC6328235 DOI: 10.1371/journal.pntd.0007035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/10/2019] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Erythema nodosum leprosum (ENL) is a systemic inflammatory complication occurring mainly in patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL). Prednisolone is widely used for treatment of ENL reactions. However, it has been reported that prolonged treatment with prednisolone increases the risk for prednisolone-induced complications such as osteoporosis, diabetes, cataract and arteriosclerosis. It has been speculated that perhaps these complications result from lipid profile alterations by prednisolone. The effects of extended prednisolone treatment on lipid profiles in ENL patients have not been studied in leprosy patients with ENL reactions. Therefore, in this study we conducted a case-control study to investigate the changes in lipid profiles and serological responses in Ethiopian patients with ENL reaction after prednisolone treatment. METHODS A prospective matched case-control study was employed to recruit 30 patients with ENL and 30 non-reactional LL patient controls at ALERT Hospital, Ethiopia. Blood samples were obtained from each patient with ENL reaction before and after prednisolone treatment as well as from LL controls. The serological host responses to PGL-1, LAM and Ag85 M. leprae antigens were measured by ELISA. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured by spectrophotometric method. RESULTS The host antibody response to M. leprae PGL-1, LAM and Ag85 antigens were significantly reduced in patients with ENL reactions compared to LL controls after treatment. Comparison between patients with acute and chronic ENL showed that host-response to PGL-1 was significantly reduced in chronic ENL after prednisolone treatment. Untreated patients with ENL reactions had low lipid concentration compared to LL controls. However, after treatment, both groups had comparable lipid profiles except for LDL, which was significantly higher in patients with ENL reaction. Comparison within the ENL group before and after treatment showed that prednisolone significantly increased LDL and HDL levels in ENL patients and this was more prominent in chronic ENL than in acute patients with ENL. CONCLUSION The significantly increased prednisolone-induced LDL and TG levels, particularly in patients with chronic ENL reactions, is a concern in the use of prednisolone for extended periods in ENL patients. The findings highlight the importance of monitoring lipid profiles during treatment of patients to minimize the long-term risk of prednisolone-induced complications.
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Affiliation(s)
- Edessa Negera
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Melaku Tilahun
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Saba M. Lambert
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Stephen L. Walker
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - John S. Spencer
- Department of Microbiology, Immunology & Pathology, Colorado State University, Fort Collins, CO, United States of America
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Hazel M. Dockrell
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Diana N. Lockwood
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Rao RT, Scherholz ML, Androulakis IP. Modeling the influence of chronopharmacological administration of synthetic glucocorticoids on the hypothalamic-pituitary-adrenal axis. Chronobiol Int 2018; 35:1619-1636. [PMID: 30059634 PMCID: PMC6292202 DOI: 10.1080/07420528.2018.1498098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/18/2018] [Accepted: 07/04/2018] [Indexed: 01/18/2023]
Abstract
Natural glucocorticoids, a class of cholesterol-derived hormones, modulate an array of metabolic, anti-inflammatory, immunosuppressive and cognitive signaling. The synthesis of natural glucocorticoids, largely cortisol in humans, is regulated by the hypothalamic-pituitary-adrenal (HPA) axis and exhibits pronounced circadian variation. Considering the central regulatory function of endogenous glucocorticoids, maintenance of the circadian activity of the HPA axis is essential to host survival and chronic disruption of such activity leads to systemic complications. There is a great deal of interest in synthetic glucocorticoids due to the immunosuppressive and anti-inflammatory properties and the development of novel dosing regimens that can minimize the disruption of endogenous activity, while still maintaining the pharmacological benefits of long-term synthetic glucocorticoid therapy. Synthetic glucocorticoids are associated with an increased risk of developing the pathological disorders related to chronic suppression of cortisol rhythmicity as a result of the potent negative feedback by synthetic glucocorticoids on the HPA axis precursors. In this study, a mathematical model was developed to explore the influence of chronopharmacological dosing of exogenous glucocorticoids on the endogenous cortisol rhythm considering intra-venous and oral dosing. Chronic daily dosing resulted in modification of the circadian rhythmicity of endogenous cortisol with the amplitude and acrophase of the altered rhythm dependent on the administration time. Simulations revealed that the circadian features of the endogenous cortisol rhythm can be preserved by proper timing of administration. The response following a single dose was not indicative of the response following long-term, repeated chronopharmacological dosing of synthetic glucocorticoids. Furthermore, simulations revealed the inductive influence of long-term treatment was only associated with low to moderate doses, while high doses generally led to suppression of endogenous activity regardless of the chronopharmacological dose. Finally, chronic daily dosing was found to alter the responsiveness of the HPA axis, such that a decrease in the amplitude of the cortisol rhythm resulted in a partial loss in the time-of-day dependent response to CRH stimulation, while an increase in the amplitude was associated with a more pronounced time-of-day dependence of the response.
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Affiliation(s)
- Rohit T. Rao
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, 98 Brett Road, Piscataway, NJ 08854
| | - Megerle L. Scherholz
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, 98 Brett Road, Piscataway, NJ 08854
| | - Ioannis P. Androulakis
- Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, 98 Brett Road, Piscataway, NJ 08854
- Department of Biomedical Engineering, Rutgers The State University of New Jersey, 599 Taylor Road, Piscataway, NJ 08854
- Correspondence: I.P. Androulakis, 599 Taylor Road, Biomedical Engineering Department, Rutgers University, Piscataway, NJ 08854, , tel: 848-445-6561, fax: 732-445-3753
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Gender-based personalized pharmacotherapy: a systematic review. Arch Gynecol Obstet 2017; 295:1305-1317. [PMID: 28378180 DOI: 10.1007/s00404-017-4363-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/29/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE In general, male and female are prescribed the same amount of dosage even if most of the cases female required less dosage than male. Physicians are often facing problem on appropriate drug dosing, efficient treatment, and drug safety for a female in general. To identify and synthesize evidence about the effectiveness of gender-based therapy; provide the information to patients, providers, and health system intervention to ensure safety treatment; and minimize adverse effects. METHODS We performed a systematic review to evaluate the effect of gender difference on pharmacotherapy. Published articles from January 1990 to December 2015 were identified using specific term in MEDLINE (PubMed), EMBASE, and the Cochrane library according to search strategies that strengthen the reporting of observational and clinical studies. RESULTS Twenty-six studies fulfilled the inclusion criteria for this systematic review, yielding a total of 6309 subjects. We observed that female generally has a lower the gastric emptying time, gastric PH, lean body mass, and higher plasma volume, BMI, body fat, as well as reduce hepatic clearance, difference in activity of Cytochrome P450 enzyme, and metabolize drugs at different rate compared with male. Other significant factors such as conjugation, protein binding, absorption, and the renal elimination could not be ignored. However, these differences can lead to adverse effects in female especially for the pregnant, post-menopausal, and elderly women. CONCLUSION This systematic review provides an evidence for the effectiveness of dosage difference to ensure safety and efficient treatment. Future studies on the current topic are, therefore, recommended to reduce the adverse effect of therapy.
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Hwangbo Y, Lee EK. Acute Hyperglycemia Associated with Anti-Cancer Medication. Endocrinol Metab (Seoul) 2017; 32:23-29. [PMID: 28345313 PMCID: PMC5368117 DOI: 10.3803/enm.2017.32.1.23] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 12/16/2022] Open
Abstract
Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are well known to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patients with hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-induced hyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucose output. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, and fasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose, and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR) inhibitors are associated with a high incidence of hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1) antibody treatment, induces hyperglycemia with a prevalence of 0.1%. The proposed mechanism of immunotherapy-induced hyperglycemia is an autoimmune process (insulitis). Withdrawal of the PD-1 inhibitor is the primary treatment for severe hyperglycemia. The efficacy of glucocorticoid therapy is not fully established and the decision to resume PD-1 inhibitor therapy depends on the severity of the hyperglycemia. Diabetic patients should achieve optimized glycemic control before initiating treatment, and glucose levels should be monitored periodically in patients initiating mTOR inhibitor or PD-1 inhibitor therapy. With regard to hyperglycemia caused by anti-cancer therapy, frequent monitoring and proper management are important for promoting the efficacy of anti-cancer therapy and improving patients' quality of life.
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Affiliation(s)
- Yul Hwangbo
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.
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37
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Momper JD, Misel ML, McKay DB. Sex differences in transplantation. Transplant Rev (Orlando) 2017; 31:145-150. [PMID: 28262425 DOI: 10.1016/j.trre.2017.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 01/01/2023]
Abstract
Sex plays a role in the incidence and progression of a wide variety of diseases and conditions related to transplantation. Additionally, a growing body of clinical and experimental evidence suggests that sex can impact the pharmacokinetics and pharmacodynamics of several commonly used immunosuppressive and anti-infective drugs in transplant recipients. A better understanding of these sex differences will facilitate advances in individualizing treatment for patients and improve outcomes of solid organ transplantation. Here, we provide a review of sex-related differences in transplantation and highlight opportunities for future research directions.
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Affiliation(s)
- Jeremiah D Momper
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego/La Jolla, CA
| | - Michael L Misel
- Kidney Transplant/Department of Pharmacy Services, UC San Diego Health System, University of California, San Diego/La Jolla, CA
| | - Dianne B McKay
- Division of Nephrology-Hypertension, School of Medicine, University of California, San Diego/La Jolla, CA.
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Fu J, Cuppen BVJ, Welsing PMJ, van Wietmarschen H, Harms AC, Berger R, Koval S, Fritsch-Stork RDE, Bijlsma JWJ, Hankemeier T, van der Greef J, Lafeber FPJG. Differences between serum polar lipid profiles of male and female rheumatoid arthritis patients in response to glucocorticoid treatment. Inflammopharmacology 2016; 24:397-402. [PMID: 27682325 PMCID: PMC5119840 DOI: 10.1007/s10787-016-0284-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/21/2016] [Indexed: 01/18/2023]
Abstract
Objective As there are pharmacological differences between males and females, and glucocorticoid (GC) treatment is associated with increased cardiovascular mortality rate in rheumatoid arthritis (RA) patients, it is important to study serum polar lipid profiles of male and female patients in response to GC therapy. Gender differences may require an adjustment to the treatment strategy for a selection of patients. Methods Serum samples from 281 RA patients were analysed using a targeted lipidomics platform. The differences in GC use and gender on polar lipid profiles were cross sectionally examined by multiple linear regressions, while correcting for confounding factors. Results Differences in polar lipids between GC users and non-GC users in females and males were merely restricted to lysophospholipids (lysophosphatidylcholines and lysophosphatidylethanolamines). Lysophospholipids in female patients treated with GCs were significantly higher than female patients not treated with GCs (p = 6.0 E−6), whereas no significant difference was observed in male GC users versus non-users (p = 0.397). Conclusion The lysophospholipid profiles in response to GCs were significantly different between male and female RA patients, which may have implications for the cardiovascular risk of GC treatment. Electronic supplementary material The online version of this article (doi:10.1007/s10787-016-0284-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junzeng Fu
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands. .,Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands.
| | - Bart V J Cuppen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Herman van Wietmarschen
- Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands
| | - Amy C Harms
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Ruud Berger
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Slavik Koval
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Ruth D E Fritsch-Stork
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,1st Medical Department and Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria.,Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria
| | - Johannes W J Bijlsma
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Thomas Hankemeier
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Jan van der Greef
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands.,TNO, Netherlands Organization for Applied Scientific Research, Microbiology and Systems Biology, Zeist, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Floris P J G Lafeber
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT. Bone Marrow Transplant 2016; 51:1041-9. [PMID: 27042848 DOI: 10.1038/bmt.2016.81] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are under-recognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.
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Kasang C, Kalluvya S, Majinge C, Kongola G, Mlewa M, Massawe I, Kabyemera R, Magambo K, Ulmer A, Klinker H, Gschmack E, Horn A, Koutsilieri E, Preiser W, Hofmann D, Hain J, Müller A, Dölken L, Weissbrich B, Rethwilm A, Stich A, Scheller C. Effects of Prednisolone on Disease Progression in Antiretroviral-Untreated HIV Infection: A 2-Year Randomized, Double-Blind Placebo-Controlled Clinical Trial. PLoS One 2016; 11:e0146678. [PMID: 26812052 PMCID: PMC4727920 DOI: 10.1371/journal.pone.0146678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-disease progression correlates with immune activation. Here we investigated whether corticosteroid treatment can attenuate HIV disease progression in antiretroviral-untreated patients. METHODS Double-blind, placebo-controlled randomized clinical trial including 326 HIV-patients in a resource-limited setting in Tanzania (clinicaltrials.gov NCT01299948). Inclusion criteria were a CD4 count above 300 cells/μl, the absence of AIDS-defining symptoms and an ART-naïve therapy status. Study participants received 5 mg prednisolone per day or placebo for 2 years. Primary endpoint was time to progression to an AIDS-defining condition or to a CD4-count below 200 cells/μl. RESULTS No significant change in progression towards the primary endpoint was observed in the intent-to-treat (ITT) analysis (19 cases with prednisolone versus 28 cases with placebo, p = 0.1407). In a per-protocol (PP)-analysis, 13 versus 24 study participants progressed to the primary study endpoint (p = 0.0741). Secondary endpoints: Prednisolone-treatment decreased immune activation (sCD14, suPAR, CD38/HLA-DR/CD8+) and increased CD4-counts (+77.42 ± 5.70 cells/μl compared to -37.42 ± 10.77 cells/μl under placebo, p < 0.0001). Treatment with prednisolone was associated with a 3.2-fold increase in HIV viral load (p < 0.0001). In a post-hoc analysis stratifying for sex, females treated with prednisolone progressed significantly slower to the primary study endpoint than females treated with placebo (ITT-analysis: 11 versus 21 cases, p = 0.0567; PP-analysis: 5 versus 18 cases, p = 0.0051): No changes in disease progression were observed in men. CONCLUSIONS This study could not detect any significant effects of prednisolone on disease progression in antiretroviral-untreated HIV infection within the intent-to-treat population. However, significant effects were observed on CD4 counts, immune activation and HIV viral load. This study contributes to a better understanding of the role of immune activation in the pathogenesis of HIV infection. TRIAL REGISTRATION ClinicalTrials.gov NCT01299948.
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Affiliation(s)
- Christa Kasang
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
- Medical Mission Institute, Salvatorstrasse 7, 97067 Würzburg, Germany
| | - Samuel Kalluvya
- Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania
- Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | | | - Gilbert Kongola
- Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Mathias Mlewa
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
- Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania
| | - Irene Massawe
- Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania
| | | | | | - Albrecht Ulmer
- HIV-Intensive Care Unit, Schwabstr. 26, 70197 Stuttgart, Germany
| | - Hartwig Klinker
- University Clinic of Würzburg, Division of Infectious Diseases, Dept. of Internal Medicine, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Eva Gschmack
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Anne Horn
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Eleni Koutsilieri
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Wolfgang Preiser
- Division of Medical Virology, National Health Laboratory Service / University of Stellenbosch, Tygerberg 7505, South Africa
| | - Daniela Hofmann
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Johannes Hain
- University of Würzburg, Institute of Mathematics and Informatics, Chair of Mathematics VIII (Statistics), Am Hubland, 97074 Würzburg, Germany
| | - Andreas Müller
- Medical Mission Institute, Salvatorstrasse 7, 97067 Würzburg, Germany
| | - Lars Dölken
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Benedikt Weissbrich
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - Axel Rethwilm
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
| | - August Stich
- Medical Mission Institute, Salvatorstrasse 7, 97067 Würzburg, Germany
| | - Carsten Scheller
- University of Würzburg, Institute of Virology and Immunobiology, Versbacher Strasse 7, 97078 Würzburg, Germany
- * E-mail:
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Kaplan CP, Nápoles AM, Narine S, Gregorich S, Livaudais-Toman J, Nguyen T, Leykin Y, Roach M, Small EJ. Knowledge and attitudes regarding clinical trials and willingness to participate among prostate cancer patients. Contemp Clin Trials 2015; 45:443-448. [PMID: 26435199 DOI: 10.1016/j.cct.2015.09.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Enrollment of minorities in clinical trials remains low. Through a California population-based study of men with early stage prostate cancer, we examined the relationships between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate in clinical trials. METHODS From November 2011-November 2012, we identified all incident cases of prostate cancer in African American, Latino, and Asian American men ages 18-75 years, and a random sample of white men diagnosed in 2008, through the California Cancer Registry, living within 60 miles of a site offering ≥ 1 clinical trial. Participants completed a 30-min telephone interview in English, Spanish, or Chinese. In this cross-sectional population-based study, multivariable logistic regression was used to estimate associations between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate. RESULTS Of 855 participants, 52% were ≥ 65 years, 42% were white, 24% Latino, 19% African American and 15% Asian American. The majority (81%) had medium-to-high health literacy. Compared to non-Latino white men, African American men were less likely to have above average knowledge of clinical trials (OR=0.55; CI=0.35-0.86), as were Asian American (OR=0.55; CI=0.33-0.93) and Latino men (OR=0.30; CI=0.18-0.48). There were no racial/ethnic differences in willingness to participate. The attitude that "researchers are the main beneficiaries" was negatively associated with willingness (OR=0.63; CI=0.43-0.93); the attitude that "patients are the main beneficiaries" was positively associated with willingness to participate (OR=1.57; CI=1.07-2.29). CONCLUSIONS Men with early stage prostate cancer are willing to take part in clinical trials and this willingness does not vary by race/ethnicity.
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Affiliation(s)
- Celia P Kaplan
- Department of Medicine, Division of General Internal Medicine,University of CaliforniaSan Francisco, USA; Helen Diller Family Comprehensive Cancer Center,University of CaliforniaSan Francisco, USA.
| | - Anna Maria Nápoles
- Department of Medicine, Division of General Internal Medicine,University of CaliforniaSan Francisco, USA; Helen Diller Family Comprehensive Cancer Center,University of CaliforniaSan Francisco, USA
| | - Steven Narine
- Helen Diller Family Comprehensive Cancer Center,University of CaliforniaSan Francisco, USA
| | - Steven Gregorich
- Department of Medicine, Division of General Internal Medicine,University of CaliforniaSan Francisco, USA
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine,University of CaliforniaSan Francisco, USA
| | - Tung Nguyen
- Department of Medicine, Division of General Internal Medicine,University of CaliforniaSan Francisco, USA; Helen Diller Family Comprehensive Cancer Center,University of CaliforniaSan Francisco, USA
| | - Yan Leykin
- Department of Psychiatry,University of CaliforniaSan Francisco, USA
| | - Mack Roach
- Radiation Oncology, University of California, San Francisco, USA
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center,University of CaliforniaSan Francisco, USA; Department of Medicine, Division of Hematology and Oncology,University of CaliforniaSan Francisco, USA
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Bergmann TK, Isbel NM, Barraclough KA, Campbell SB, McWhinney BC, Staatz CE. Comparison of the influence of cyclosporine and tacrolimus on the pharmacokinetics of prednisolone in adult male kidney transplant recipients. Clin Drug Investig 2014; 34:183-8. [PMID: 24385281 DOI: 10.1007/s40261-013-0162-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cyclosporine has been observed to precipitate cushingoid features in kidney transplant recipients already on prednisolone. Some pharmacokinetic studies have demonstrated increased prednisolone exposure in patients on cyclosporine therapy compared with azathioprine, whereas other studies have found no difference. The objective of this study was to determine whether cyclosporine impacts on prednisolone exposure as compared with tacrolimus. METHODS Adult male kidney transplant recipients treated with prednisolone and either cyclosporine or tacrolimus were recruited for pharmacokinetic blood sampling at the outpatient clinic at the Princess Alexandra Hospital, Brisbane, Australia. Prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography. Dose-adjusted area under the plasma concentration-time curve (AUC) of free and total prednisolone was estimated using a previously developed limited sampling strategy and non-compartmental analysis. RESULTS A total of 55 patients were eligible for analysis; 38 % received cyclosporine and 62 % received tacrolimus co-therapy. No significant difference in mean dose-adjusted total prednisolone AUC from 0 to 6 h post-dose or mean dose-adjusted free prednisolone AUC from 0 to 12 h was observed between the cyclosporine and tacrolimus groups (449 versus 428 nmol·h/L/mg, p = 0.43, and 32 versus 30 nmol·h/L/mg, p = 0.51, respectively). CONCLUSION Cyclosporine does not change the dose-adjusted exposure of prednisolone compared with tacrolimus. Adult kidney transplant recipients can therefore continue on their usual prednisolone dose when changing therapy between cyclosporine and tacrolimus.
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Siegmund T. [Glucocorticoid-induced hyperglycemia - mechanisms, detection and therapeutic management]. MMW Fortschr Med 2014; 156 Spec no 2:90-92. [PMID: 25552026 DOI: 10.1007/s15006-014-3692-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Perez A, Jansen-Chaparro S, Saigi I, Bernal-Lopez MR, Miñambres I, Gomez-Huelgas R. Glucocorticoid-induced hyperglycemia. J Diabetes 2014; 6:9-20. [PMID: 24103089 DOI: 10.1111/1753-0407.12090] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/17/2013] [Accepted: 09/12/2013] [Indexed: 12/19/2022] Open
Abstract
Corticosteroid-induced hyperglycemia is a common medical problem that can lead to frequent emergency room visits, hospital admissions and prolonged hospital stay, in addition to the well known morbidity associated with hyperglycemia. However, the diagnosis and treatment of corticosteroid-induced hyperglycemia is surprisingly undervalued by most professionals, probably because of the lack of quality studies to determine specific strategies of action. In the present review, we discuss the pathophysiology of corticosteroid-induced hyperglycemia, focusing on diverse patterns of hyperglycemia induced by the different formulations, and provide clues for diagnosis based on the duration of treatment and the administration schedule of corticosteroids. We propose a treatment strategy based on both the pathophysiology of the process and the mechanism of action of different corticosteroids, and take into account dosing and administration timing to predict the duration of therapy. Finally, we propose treatment goals that differ slightly between the transient and continuous use of corticosteroids based on evidence from clinical practice guidelines of diabetes care both in ambulatory and hospital settings.
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Affiliation(s)
- Antonio Perez
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i San Pau, Barcelona, Spain; CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Bannwarth B, Kostine M, Poursac N. Are there concerns about generic medicines in rheumatology? Joint Bone Spine 2014; 81:1-3. [DOI: 10.1016/j.jbspin.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/29/2022]
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Influence of body condition on plasma prednisolone and prednisone concentrations in clinically healthy cats after single oral dose administration. Res Vet Sci 2013; 95:225-30. [DOI: 10.1016/j.rvsc.2013.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/19/2022]
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Abstract
OBJECTIVES Provide treatment guidelines for glucocorticoid-induced hyperglycemia and to understand the clinical implications of glucocorticoid-induced hyperglycemia. METHODS The authors analyzed an electronic search (Medline) and a literature review of the pertinent articles published from 1980 to September 2012. RESULTS In patients treated with glucocorticoids, the odds ratio for development of new-onset diabetes mellitus has been reported to be 1.36 to 2.31. The prevalence of abnormal glucose metabolism in post renal transplant patients taking glucocorticoids has been reported to be 17% to 32%. Sustained glucocorticoid treatment increases the potential for future cardiovascular disease through multiple pathways, resulting in a trade-off between benefit and harm. Complications related to glucocorticoid treatments are associated with the total glucocorticoid dose and duration of therapy. Other risk factors include age and body mass index. Understanding the pharmacodynamics and clinical implications of glucocorticoid-induced hyperglycemia can promote recognition and improvement of its treatment. CONCLUSIONS Glucocorticoid-induced hyperglycemia has significant clinical implications in patients with diabetes mellitus and without diabetes mellitus. Early recognition and proper proactive management of glucocorticoid-induced hyperglycemia should enhance care for patients receiving glucocorticoid treatment. Furthermore, treatment has been effective for both the inpatient and the outpatient settings.
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Mager DE, Lin SX, Blum RA, Lates CD, Jusko WJ. Dose Equivalency Evaluation of Major Corticosteroids: Pharmacokinetics and Cell Trafficking and Cortisol Dynamics. J Clin Pharmacol 2013; 43:1216-27. [PMID: 14551176 DOI: 10.1177/0091270003258651] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The integrity of current corticosteroid dose equivalency tables, as assessed by mechanistic models for cell trafficking and cortisol dynamics, was investigated in this study. Single, presumably equivalent, doses of intravenous hydrocortisone, methylprednisolone, dexamethasone, and oral prednisolone were given to 5 white men, according to total body weight, in a 5-way crossover, placebo-controlled study. Pharmacodynamic (PD) response-time profiles for T helper cells, T suppressor cells, neutrophils, and adrenal suppression were evaluated by extended indirect response models. For adrenal suppression, prednisolone appears to be less potent than methylprednisolone or dexamethasone. A good correlation was found between the estimated in vivo EC50 values and relative receptor affinity (equilibrium dissociation constants normalized to dexamethasone). Area under the effect curves of all PD responses was calculated using a linear-trapezoidal method. Although T helper cell trafficking and adrenal suppression achieved significant differences by repeated-measures ANOVA (p = 0.014 and 0.022), post hoc analysis using the Bonferroni method revealed no difference between treatments. Although limited by the use of single doses and a relatively small sample size, this study applies mechanistic models for several biomarkers showing that currently used dosing tables reflect reasonable dose equivalency relationships for four corticosteroids.
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Roy A, Mould DR, Wang XF, Tay L, Raymond R, Pfister M. Modeling and Simulation of Abatacept Exposure and Interleukin-6 Response in Support of Recommended Doses for Rheumatoid Arthritis1. J Clin Pharmacol 2013; 47:1408-20. [DOI: 10.1177/0091270007307573] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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