In vitro Modified Release Studies on Melatoninergic Fluorinated Phenylalkylamides: Circumventing their Lipophilicity for Oral Administration

INTRODUCTION

In an attempt to circumvent the lipophilicity burden for the oral administration of new potent synthetic melatoninergic fluorine-substituted methoxyphenylalkyl amides, we conducted in vitro modified release studies using carefully selected matrix tablets' biopolymeric materials in different ratios.

METHOD

In particular, we sought to attain release profiles of these analogues similar to that of the parent compound, the chronobiotic hormone Melatonin (MLT), and also of the commercially available drug, Circadin®.

RESULT

It was found that some of these systems, albeit being more lipophilic than MLT, mimic the in vitro release patterns of melatonin and Circadin®.

CONCLUSION

Moreover, a number of these derivatives were proven suitable for dealing with sleep onset problems, whilst others for dealing with combined sleep onset/sleep maintenance dysfunctions.

Design and Development of Low- and Medium-Viscosity Alginate Beads Loaded with Pluronic® F-127 Nanomicelles

The anionic polymer sodium alginate, a linear copolymer of guluronic and mannuronic acids, is primarily present in brown algae. Copolymers are used in the sodium alginate preparation process to confer on the material strength and flexibility. Micelles and other polymeric nanoparticles are frequently made using the triblock copolymer Pluronic^® F-127. The purpose of the present study is to determine the effect of sodium alginate's viscosity (low and medium) and the presence of Pluronic^® F-127 micelles on the swelling behavior of the prepared pure beads and those loaded with Pluronic^® F-127 micelles. The Pluronic^® F-127 nanomicelles have a size of 120 nm. The swelling studies were carried out at pH = 1.2 (simulated gastric fluid-SGF) for two hours and at pH = 6.8 (simulated intestinal fluid-SIF) for four more hours. The swelling of both low- and medium-viscosity alginate beads was minor at pH = 1.2, irrespective of the use of Pluronic^® F-127 nanomicelles. At pH = 6.8, without Pluronic^® F-127, the beads showed an enhanced swelling ratio for the first four hours, which was even higher in the medium-viscosity alginate beads. With the addition of Pluronic^® F-127, the beads were dissolved in the first and second hour, in the case of the low- and medium-alginate's viscosity, respectively. In other words, the behavior of the mixed hydrogels was the same during the swelling experiments. Therefore, the presence of Pluronic^® F-127 nanomicelles and medium-viscosity sodium alginate leads to a higher swelling ratio. A model drug, acetyl salicylic acid (ASA), was also encapsulated in the mixed beads and ASA's release studies were performed. In conclusion, the prepared systems, which are well characterized, show potential as delivery platforms for the oral delivery of active pharmaceutical ingredients and biopharmaceuticals.

Potent Lipophilic Melatoninergic x-fluoro-y-methoxy Substituted Phenylalkylamides: Molecular Dynamics Calculations and in vitro Modified Release in Aqueous Media from Tablet Formulations

INTRODUCTION

We report herein on the design and development of matrix tablets containing potent synthetic melatonin (MLT) receptor analogues, the x-fluoro-y-methoxy substitiuted phenylalkylamides (compounds I-IV), the preparation and melatoninergic potency of which was recently communicated.

METHODS

The presence of the fluorine atom in compounds I-IV, besides not affecting their binding affinity, compared to the pineal hormone melatonin, it also slows down their metabolism, which is a major drawback of MLT. However, as fluorine increases the lipophilicity, solid pharmaceutical formulations of I-IV, involving the appropriate biopolymers for their modified release in aqueous media, were developed in the context of the present work.

RESULTS

The release profile of analogues I-IV was found to be similar to that of MLT and also of the commercially available drug, Circadin®. Some of these systems are suitable for dealing with sleep onset problems, whilst others for dealing with combined sleep onset/sleep maintenance problems.

CONCLUSION

Apart from the nature and relevant content of the formulants used, this bimodal release profile of the new analogues depends, to a large extent, on the diverse structural arrangement of their side chains in space, as nicely demonstrated by the molecular dynamics calculations, conducted in the context of this study.

Dissolution Assay of Bupropion/Naltrexone Hydrochloride Salts of Bilayer Composition Tablets Following the Development and Validation of a Novel HPLC Method

Compounded medicinal products containing bupropion hydrochloride (BUP·HCl) and naltrexone hydrochloride (NTX·HCl) are available as adjunct therapy for the management of weight in obese/overweight adults. The present work describes the development and validation of a novel RP-HPLC method for a simultaneous quantitation during the dissolution of both drugs from compounded bilayer composition tablets. The method involves a Nucleosil 100-3 C-18 column (4.6 × 150 mm) and a mobile phase of a 70%/30% v/v ACN/KH₂PO₄·H₂O aqueous solution of a 5 mM concentration. The flow rate was set at 1.35 mL/min and the detection was conducted using UV spectrophotometry (λ_max 214 nm). The method was validated according to the ICH guidelines and fulfilled the specifications for the specificity, linearity, accuracy, precision and stability for both the sample and standard solutions. Furthermore, the robustness of the method was evaluated by applying a fractional factorial experimental design and by utilizing both graphical and statistical approaches to identify the HPLC factors that should be strictly controlled during the analysis. The method proved to be suitable for the analysis of the dissolution samples and, consequently, the release of BUP·HCl and NTX·HCl from the formulations.

Environmental impacts due to the use of sunscreen products: a mini-review

Sunscreen use has increased in recent years, as sunscreen products minimize the damaging effects of solar radiation. Active ingredients called ultraviolet (UV) filters or UV agents, either organic or inorganic, responsible for defending skin tissue against harmful UV rays, are incorporated in sunscreen formulations. UV agents have a serious impact on many members of bio communities, and they are transferred to the environment either directly or indirectly. Many organic UV filters are found to be accumulated in marine environments because of high values of the octanol/water partition coefficient. However, due to the fact that UV agents are not stable in water, unwanted by-products may be formed. Experimental studies or field observations have shown that organic UV filters tend to bioaccumulate in various aquatic animals, such as corals, algae, arthropods, mollusks, echinoderms, marine vertebrates. This review was conducted in order to understand the effects of UV agents on both the environment and marine biota. In vivo and in vitro studies of UV filters show a wide range of adverse effects on the environment and exposed organisms. Coral bleaching receives considerable attention, but the scientific data identify potential toxicities of endocrine, neurologic, neoplastic and developmental pathways. However, more controlled environmental studies and long-term human use data are limited. Several jurisdictions have prohibited specific UV filters, but this does not adequately address the dichotomy of the benefits of photoprotection vs lack of eco-friendly, safe, and approved alternatives.

Modified release of acetaminophen from matrix tablet formulations: Influence of tablet geometry

Background:

Acetaminophen (APAP) or otherwise called paracetamol is a widely used over-the-counter, analgesic (common conditions treated include headaches, backache, toothache, muscle aches, arthritis, sore throat etc.) and antipyretic drug. It can be administered orally, in the form of a tablet (plain, effervescent, orodispersable, etc.) or liquid, rectally in the form of suppository or by injection (intravenously or intramuscularly). It is well absorbed orally with a plasma elimination half-life ranging from 1 to 4 h. The modified release oral formulation can prolong its therapeutic effects by maintaining APAP average plasma concentrations.

Objective:

In the context of this work, two APAP formulation tablets with different geometries were produced from standard pharmaceutical excipients, to investigate the role of altered tablet geometry in modified oral drug delivery.

Methods:

APAP tablets were prepared by direct compression, using hydroxypropyl methylcellulose (HPMC K15M), polyvinylpyrrolidone (PVP, MW: 55,000) and magnesium stearate, as ingredients. The release profiles were probed in aqueous dissolution media (pH 1.2 and 6.8), to simulate the conditions in the gastrointestinal tract, in a United States Pharmacopeia (USP) dissolution paddle apparatus II and analyzed using a ultraviolet (UV) spectrophotometer (λmax = 244 nm).

Results:

The results indicated that the tablets were within the acceptable range of all evaluation parameters (tablet dimensions, drug content, weight variation, and breaking force) as defined by the international standards stated in the US Pharmacopoeia. The dissolution results showed that the APAP’s release profile was controlled by the tablets’ different geometries and specifically the surface area (SA) and the surface area/volume (SA/V) ratio of the different tablets. The tablets with smaller SA/V ratios and SA showed slower drug release, indicative of a modified release motif.

Conclusion:

Altered tablet geometry plays an important role in APAP modified oral drug delivery.

Excipients Used for Modified Nasal Drug Delivery: A Mini-Review of the Recent Advances

The ongoing challenging task in the field of nasal drug delivery is the maintenance of an efficient concentration of the active substance in the target area for an adequate period of time. Thus, there is an urgent need to develop effective new strategies for drug delivery to the nose, using cutting edge technology and materials for this particular type of drug delivery. This review gives an account of the critical components of nasal drug delivery and the parameters influencing drug absorption in the nose, including the excipients required for modified drug administration.

Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial

BACKGROUND

Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection.

OBJECTIVE

To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone.

DESIGN

Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978).

SETTING

Multinational, multicenter trial.

PARTICIPANTS

Adults hospitalized with COVID-19.

INTERVENTION

Intravenous ensovibep, 600 mg, or placebo.

MEASUREMENTS

Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90.

RESULTS

An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep).

LIMITATION

The trial was prematurely stopped because of futility, limiting power for the primary outcome.

CONCLUSION

Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Investigation of Molecular Weight, Polymer Concentration and Process Parameters Factors on the Sustained Release of the Anti-Multiple-Sclerosis Agent Teriflunomide from Poly(ε-caprolactone) Electrospun Nanofibrous Matrices

In the current work, a series of PCL polyesters with different molecular weights was synthesized and used for the fabrication of nanofibrous patches via electrospinning, as sustained release matrices for leflunomide’s active metabolite, teriflunomide (TFL). The electrospinning conditions for each sample were optimized and it was found that only one material with high Mn (71,000) was able to produce structures with distinct fibers devoid of the presence of beads. The successful preparation of the fibers was determined by scanning electron microscopy (SEM).TFL (10, 20 and 30 wt%) in three different concentrations was incorporated into the prepared nanofibers, which were used in in vitro drug release experiments. The drug-loaded nanofibrous formulations were further characterized by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and powder X-ray diffractometry (XRD).It was found that TFL was incorporated in an amorphous form inside the polymeric nanofibers and that significant molecular interactions were formed between the drug and the polyester. Additionally, in vitro dissolution studies showed that the PCL/TFL-loaded nanofibers exhibit a biphasic release profile, having an initial burst release phase, followed by a sustained release until 250 h. Finally, a kinetic analysis of the obtained profiles revealed that the drug release was directly dependent on the amount TFL incorporated into the nanofibers.

Modified Release of the Pineal Hormone Melatonin from Matrix Tablets Containing Poly(L-lactic Acid) and Its PLA-co-PEAd and PLA-co-PBAd Copolymers

In terms of drug delivery, the attractive properties of poly(L-lactic acid) (PLA) and its aliphatic polyesters, poly(ethylene adipate) (PEAd) and poly(butylene adipate) (PBAd), render them ideal co-formulants for the preparation of modified-release pharmaceutical formulations. Furthermore, we have previously demonstrated that by adding a “softer” aliphatic polyester onto the macromolecular chain of PLA, i.e., PEAd or PBAd, resulting in the formation of the PLA’s copolymers (PLA-co-PEAd and PLA-co-PBAd, in 95/5, 90/10, 75/25 and 50/50 weight ratios), the hydrolysis rate is also severely affected, leading to improved dissolution rates of the active pharmaceutical ingredients (API). In the present report, we communicate our findings on the in vitro modified release of the chronobiotic hormone melatonin (MLT), in aqueous media (pH 1.2 and 6.8), from poly(L-lactic acid) and the aforementioned copolymer matrix tablets, enriched with commonly used biopolymers, such as hydroxypropylmethylcellulose (HPMC K15), lactose monohydrate, and sodium alginate. It was found that, depending on the composition and the relevant content of these excipients in the matrix tablets, the release of MLT satisfied the sought targets for fast sleep onset and sleep maintenance. These findings constitute a useful background for pursuing relevant in vivo studies on melatonin in the future.

Recent Advances in the Excipients Used in Modified Release Vaginal Formulations

The formulation of an ideal vaginal drug delivery system (DDS), with the requisite properties, with respect to safety, efficacy, patient compliance, aesthetics, harmonization with the regulatory requirements, and cost, requires a meticulous selection of the active ingredients and the excipients used. Novel excipients defined by diversity and multifunctionality are used in order to ameliorate drug delivery attributes. Synthetic and natural polymers are broadly used in pharmaceutical vaginal formulations (solid, semi-solid dosage forms, implantable devices, and nanomedicines) with a promising perspective in improving stability and compatibility issues when administered topically or systemically. Moreover, the use of biopolymers is aiming towards formulating novel bioactive, biocompatible, and biodegradable DDSs with a controllable drug release rate. Overviewing vaginal microenvironment, which is described by variable and perplexed features, a perceptive choice of excipients is essential. This review summarizes the recent advances on the excipients used in modified vaginal drug delivery formulations, in an attempt to aid the formulation scientist in selecting the optimal excipients for the preparation of vaginal products.

Recent Advances in the Excipients Used for Modified Ocular Drug Delivery

In ocular drug delivery, maintaining an efficient concentration of the drug in the target area for a sufficient period of time is a challenging task. There is a pressing need for the development of effective strategies for drug delivery to the eye using recent advances in material sciences and novel approaches to drug delivery. This review summarizes the important aspects of ocular drug delivery and the factors affecting drug absorption in the eye including encapsulating excipients (chitosan, hyaluronic acid, poloxamer, PLGA, PVCL-PVA-PEG, cetalkonium chloride, and gelatin) for modified drug delivery.

UV Filters and Their Distribution on the Skin through Safe, Non-Penetrating Vehicles

The effects of ultraviolet (UV) radiation trigger human skin reaction, which can result in erythema, photoaging, and/or skin cancer. Sunscreens play an important role against the negative effects of UV radiation on the human skin. However, they should satisfy certain criteria, with the main one being photostability, to avoid the formation of health-threatening reactive intermediates. It has to be kept in mind, however, that photo-stable UV filters have the undesirable propensity to transfer energy to molecular oxygen and generate the very reactive singlet oxygen. They should also be well tolerated, while at the same time, they should not permeate into the skin and cause toxic effects. Thus, there is an ongoing need to develop effective and safe non-penetrating sunscreen formulations. The search for innovative active substances, efficacious combinations, and the design of vehicles or carriers has led to the implementation of advanced delivery systems. This study intended to review the commonly used UV radiation thwarting agents (organic and inorganic UV filters), compile the relevant toxicity studies, evaluate their margin of safety, and assess the current situation on innovative sunscreen formulations.

Probing the Release of Bupropion and Naltrexone Hydrochloride Salts from Biopolymeric Matrices of Diverse Chemical Structures

In the last decades, the notion of including excipients in the formulations, as inert substances aiding production processes, has changed and they are recently viewed as multifunctional discrete entities. It is now well documented that excipients serve several roles, spreading from the stabilization and modified release, to providing biocompatible properties and targeting moieties. The aim of this study was to develop matrix-based oral drug delivery systems of bupropion hydrochloride (BUP·HCl) and naltrexone hydrochloride (NTX·HCl), suitable for releasing these active substances in a modified manner, providing a stable level of drug release, which is simultaneously therapeutically effective and non-toxic, thus reducing side effects, after a single dose administration, throughout the gastrointestinal tract. The new formulations, employing hydroxypropylmethycellulose (HPMC K15M) (a cellulosic polymer, which, generally hydrates to form a gelatinous layer that is critical to prevent wetting and rapid drug release from the matrices), poly(methacylic acid-co-ethyl acrylate) 1:1 (Eudragit^® L100-55: effective for site specific drug delivery in intestine), poly(ethylene oxide) (PEO) (7 × 10⁶: a high molecular weight polymer, water-soluble, in micro-granular powder form), as the rate controlling polymers, were chosen to lead to a "soothing out" release pattern of these drugs, at 0 ≤ t ≤ 120 min. Moreover, the release of the two drugs from the ulvan-based tablets, was found to follow the desired profile, throughout the entire course of the dissolution experiments.

Block copolymers based on poly(butylene adipate) and poly(L-lactic acid) for biomedical applications: synthesis, structure and thermodynamical studies

This work describes the synthesis of poly(butylene adipate) (PBAd), by melt polycondensation, poly(l-lactic acid) (PLLA), by ring opening polymerization, and the new block copolymer PLLA/PBAd in ratios 90/10, 95/5, 75/25 and 50/50. Due to the biocompatibility and low toxicity of neat PBAd and PLLA, these copolymers are suitable to be used in biomedical applications. The 1H and 13C nuclear magnetic resonance spectroscopy techniques were employed for structural characterization. The thermal transitions, with an emphasis on crystallization, were assessed by differential scanning calorimetry, supplemented by X-ray diffraction and polarized optical microscopy. Molecular mobility studies were conducted using two advanced techniques, broadband dielectric spectroscopy and thermally stimulated depolarization currents. The results from the structural techniques, in combination with each other, provided proof of the presence of PLLA and PBAd blocks and, moreover, the successful copolymer synthesis. The overall data showed that the different co-polymer compositions result directly in severe changes in the polymer crystal distribution and, indirectly, the formation of PBAd micro/nano domains surrounded by PLLA. Furthermore, it was demonstrated that both the continuity of the two polymers throughout the copolymer volume and the semicrystalline morphology can be tuned to a wide extent. The latter makes these systems quite promising envisaging biomedical applications, including the encapsulation of small molecules, e.g. drug solutions. The molecular mobility map was constructed for these systems for the first time, revealing the local (short scale) and segmental (larger nm scale) mobility of PBAd and PLLA, as well as intermediate behaviors of the copolymers.

Pineal hormone melatonin as an adjuvant treatment for COVID‑19 (Review)

The beneficial properties of the pineal hormone, melatonin, as a neuroprotective and cardioprotective agent, have been previously identified. Furthermore, melatonin plays essential roles in biological rhythms resynchronization, sleep initiation/maintenance and metabolic, ocular, rheumatological diseases. In addition to these functions, melatonin is known to exert immunomodulation, anti-inflammatory and anti-oxidative effects. Due to these properties, coupled with its non-toxic nature, melatonin has been suggested to limit viral infections; however, melatonin cannot be classified as a viricidal drug. In addition, the recent increase in the number of clinical trials on melatonin's role, as an adjuvant treatment for COVID-19, has resurged the interest of the scientific community in this hormone. The present short review aimed to improve the understanding of the antiviral/anti-COVID-19 profile of melatonin and the clinical trials that have recently been conducted, with respect to its co-administration in treating individuals with COVID-19.

Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin

Funding Acknowledgements

Type of funding sources: None.

Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.

Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.

Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin &gt;2000ng/ml (HR: 3.517, p = 0.03), and &gt;950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP &gt;34mmHg(HR: 10,134, p = 0.003), CMR T2* &lt;20msec (HR: 4.900, p = 0.018) and &lt;36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP &gt;34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin &gt;950ng/ml than &gt;2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*&lt;36msec than &lt;20msec (C index 0.825 vs. 0.810 respectively).

Conclusions. In haemoglobinopathy patients, RVSP &gt;34mmHg, ferritin &gt;2000ng/ml and CMR T2* &lt;20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin &lt;950ng/ml and CMR T2* &gt;36ms appears to improve their prognosis.

Abstract Figure.

3D-Printed Modified-Release Tablets: A Review of the Recent Advances

The broad spectrum of applications of three-dimensional printing (3D printing, 3DP) has attracted the attention of researchers working in diverse fields. In pharmaceutics, the main idea behind 3D printing products is to design and develop delivery systems that are suited to an individual’s needs. In this way, the size, appearance, shape, and rate of delivery of a wide array of medicines could be easily adjusted. The aim of this chapter is to provide a compilation of the 3D printing techniques, used for the fabrication of oral drug delivery systems, and review the relevant scientific developments in particular those with modified-release characteristics.

AB0848 IS THERE A WINDOW OF OPPORTUNITY IN EARLY PSORIATIC ARTHRITIS? RETROSPECTIVE DATA FROM A REAL LIFE SETTING

Background:

In early rheumatoid arthritis (ERA) a window of opportunity (WoO) is well established since its first proposal in 2002 (1). ERA patients achieved a better clinical outcome when DMARD therapy was initiated within the first 12-16 weeks after start of symptoms (disease duration (Xd) (2). To the best of our knowledge, comparable data are missing for early psoriatic arthritis (EPsA), even though the benefit of tight control is known in EPsA (3,4). In contrast to ERA early PsA is usually defined as Xd <24months (3,4).

Objectives:

To study in a setting of routine rheumatologic care if a WoO like in ERA also can be observed in EPsA comparable to ERA.

Methods:

n=90 consecutive outpatients with definite PsA were recruited in this retrospective longitudinal cohort study with the following inclusion criteria: DMARD- and steroid-naïve at the first time of visit in our outpatient clinic (t0), minimum follow-up of 3 years, classification as very early psoriatic arthritis (VEPsA, Xd≤3 months, n=30), late early psoriatic arthritis (LEPsA, > 3 Xd ≤ 12 months, n=30) and late psoriatic arthritis (LAPsA, Xd > 36 months, n=30). Standardized assessments had been performed at regular intervals of 3 months within the framework of routine rheumatologic care. Outcome at 3 years (t36) was analyzed within groups and between groups (DAS28, Physician Global Assessment (PhG), HAQ, fatigue, morning stiffness).

Results:

Cohorts did not differ between gender and age (mean age 54 years). There was no significant difference in DAS28, HAQ, PhG and morning stiffness at t0. Fatigue at t0 differed between cohort 1 and 3 significantly (p<0.03). In all cohorts DAS28 and PhG have been decreased at t36 significantly (minimal p< 0.006). In comparison to VEPsA LEPsA showed a significant difference in DAS28 (p<0.04) and PhG (p<0.05), but not in morning stiffness and fatigue. Highly significant differences between VEPsA and LAPsA were observed for DAS28 (p <0.007), morning stiffness (p < 0.001), PhG (p<0.05) and fatigue (p < 0.006) at t36.

Conclusion:

Significant and relevant differences between the outcomes at 3 years of patients with VEPsA, LEPsA and LAPsA could be identified in this retrospective pilot study. Particularly the highly significant difference between VEPsA and LAPsA (<3 months vs. >36months) is remarkable. The data suggest a window of opportunity also in patients with EPsA. With a time interval of Xd≤12 this window seems to be longer than in ERA. Further studies with higher number of patients were needed to confirm our findings from this real life setting.

References:

[1]O´Dell JR Treating Rheumatoid Arthritis Early: A Window of Opportunity? Arthritis Rheum 2002;46:283–285

[2]Nell VPK, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS Rheumatology 2004 43:906-914

[3]Coates LC, Moverley AR, McParland Let al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial.Lancet2015,386:2489–98.

[4]Coates LC, Mahmood F, Freeston J, Emery P, Conaghan PG, Helliwell PS Long-term follow-up of patients in the TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) trial Rheumatology (Oxford) 2019 kez369

Disclosure of Interests:

None declared

Utilization of a Single Experimental Design for the Optimization of Furosemide Modified-Release Tablet Formulations

BACKGROUND

The loop diuretic drug furosemide is widely used for the treatment of edema in various conditions, such as pulmonary, cardiac and hepatic edema, as well as cardiac infarction. Furosemide, due to its poor water solubility and low bioavailability after oral administration of conventional dosage form, is categorized as class IV in the biopharmaceutical classification system.

OBJECTIVE

In the case of furosemide, this release profile is responsible for various physiological problems, acute diuresis being the most serious. This adverse effect can be circumvented by the modified release of furosemide from tablet formulations compared to those forms designed for immediate release.

METHODS

In this report, a D-optimal combined experimental design was applied for the development of furosemide containing bilayer and compression coated tablets, aiming at lowering the drug's burst release in the acidic environment of the stomach. A D-optimal combined design was selected in order to include all requirements in one design with many levels for the factors examined. The following responses were selected as the ones reflecting better criteria for the desired drug release: dissolution at 120 min (30-40%), 300 min (60-70%) and 480 min >95%. The new formulations, suggested by the Doptimal combined design, incorporated different grades of Eudragit ® polymers (Eudragit® E100 and Eudragit® L100-55), lactose monohydrate and HPMC K15M. The dissolution profile of furosemide from these systems was probed via in vitro dissolution experiments in buffer solutions simulating the pH of the gastrointestinal tract.

RESULTS

The results indicate that the use of Eudragit® E100 in conjunction with lactose monohydrate led to 21.32-40.85 % drug release, in the gastric medium, in both compression-coated and bilayer tablets. This is lower than the release of the mainstream drug Lasix® (t=120 min, 44.5% drug release), implying longer gastric retention and drug waste minimization.

CONCLUSION

Furosemide's release in the intestinal environment, from compression coated tablets incorporating Eudragit® L100-55 and HPMC K15M in the inner core or one of the two layers of the bilayer tablets, was delayed, compared to Lasix®.

Desirability Based Optimization of New Mesalazine Modified Release Formulations: Compression Coated Tablets and Mini Tablets in Capsules

Background:

Mesalazine (5-aminosalicylic acid, 5-ASA) is a drug substance with an antiinflammatory activity, which is mainly used in the symptomatic treatment of diseases, such as Ulcerative Colitis, the Crohn's disease and the idiopathic inflammatory bowel disease. Mesalazine exerts its effect locally in the inflamed area of the intestine and not through systematic absorption, therefore the investigation of its release characteristics from solid pharmaceutical formulations is of great importance.

Objective:

The development of novel mesalazine modified release formulations with improved properties, regarding drug release in the gastrointestinal tract, by utilisation of the Design of Experiments (DoE) approach.

Methods:

D-optimal experimental design was applied. A Simplex Lattice mixture design was used for the development of suitable capsules containing 4 mini tablets and a D-optimal mixture design was used for compression-coated tablets, with the following characteristics: ≤10% release in 2 h, to minimize its degradation in the upper gastrointestinal tract, 20-40% release in 5 h for mesalazine administration in the small intestine, and quantitative release in 12 h for colonic delivery. The dissolution experiments were conducted in gastrointestinal-like fluids and pectinases to simulate the pectinolytic enzymes present in the colon.

Results:

The optimal compositions were reached via the desirability function, as a compromise to the different responses. The optimal solutions for both formulations led to colon-specific delivery of the active substance with minimal 5-ASA release in the upper gastrointestinal tract and appeared to conform with the pre-determined characteristics. Hard gelatin capsules, when filled with mini-tablets led to the aimed modified release profile, having sigmoidal characteristics and compression coated tablets led to colonic delivery.

Conclusion:

Two novel mesalazine formulations were developed with the desirable colonic release, by conducting a minimal number of experiments, as suggested by DoE experimental design.

Development and Characterization of Eudragit®-Based Electrospun Nanofibrous Mats and Their Formulation into Nanofiber Tablets for the Modified Release of Furosemide

Furosemide, a chloride channel blocker ordinarily used as a high-ceiling or loop diuretic, is practically insoluble in water and dilute acids. Due to its acidic nature, furosemide is mostly absorbed in the stomach and in the upper small intestine. Efforts have focused on the development of sustained release systems of furosemide in order to improve the effectiveness of the drug, which exhibits poor aqueous solubility and poor permeability. Recently, electrospun nanofibrous drug delivery systems have emerged as promising alternative solid-dosage forms due to their advantages of high porosity, high surface to volume ratio, and high drug-loading efficacy. Herein, a number of nanofibrous mats composed of different types of Eudragit® polymers in various concentrations and combinations loaded with furosemide were designed, successfully electrospun, and characterized using SEM, FTIR, DSC, and TGA analyses. The nanofibrous nonwovens were formulated in nanofiber tablets and the release profile of furosemide from them was evaluated at pH 1.2 and 6.8 and compared to that of physical mixture matrix tablets of analogous composition as well as to that of a commercial formulation. It was found that the release of furosemide was compatible with the gastroretentive and slower intestinal release requirements with a well-defined absorption window, while some nanofiber formulations could act as furosemide carriers in emergency situations where a relatively fast onset of its action is required, as in the case of critically ill post-traumatic patients.

In Vivo Evaluation of the Anti-Inflammatory Activity of Electrospun Micro/Nanofibrous Patches Loaded with Pinus halepensis Bark Extract on Hairless Mice Skin

Skin inflammation is the most common symptom in dermatological diseases. It is usually treated by topically applied products, such as creams, gels and lotions. Skin dressings offer a promising alternative as they are endowed with more controlled administration conditions. In this study, the anti-inflammatory activity of electrospun alginate micro/nanofibrous dressings loaded with the aqueous extract of Pinus halepensis bark (PHBE) was evaluated in vivo in mice. The upper back skin of SKH-1 female hairless mice was exposed to a single dose of ultraviolet radiation (3 MEDs) and the inflamed area was treated daily by the direct application of a nanofibrous patch. The condition of the skin was evaluated primarily on the basis of clinical observation, photo-documentation and histopathological assessment, while measurements of the erythema, hydration, transepidermal water loss (TEWL) and sebum production were also taken into account. The results showed that the topical application of alginate micro/nanofibrous dressings loaded with PHBE on UV-inflamed skin significantly attenuated inflammation damage, reducing the healing period. Increase of the loading dose of PHBE resulted in a proportional reduction of the extent, the density and the depth of skin inflammation. With the steadily increasing interest of the skin dressing industry towards nanofibrous matrices, electrospun nonwovens could serve as ideal candidates for the development of multifunctional anti-inflammatory care systems.

Fabrication and Characterization of Electrospun Nanofibers for the Modified Release of the Chronobiotic Hormone Melatonin

OBJECTIVE

Aiming at the modified release of melatonin (MLT), electrospun-MLT loaded nanofibers, filled into hard gelatin and DRcapsTM capsules, were used as formulants.

METHODS

Cellulose acetate, polyvinylpyrrolidinone and hydroxypropylmethylcellusose (HPMC 2910) were used for the preparation of the fiber matrices through electrospinning. The in vitro modified release profile of MLT from the fabricated matrices in gastrointestinal-like fluids was studied. At pH 1.2, the formulations CA1, CA2, PV1, HP1, HP2 and the composite formulations CAPV1-CAPV5 in hard gelatin capsules exhibited fast MLT release.

RESULTS

In general, the same trend was observed at pH 6.8, with the exception of CAPV1 and CAPV2. These two composite formulations delivered 52.08% and 75.25% MLT, respectively at a slower pace (6 h) when encapsulated in DRcapsTM capsules. In all other cases, the release of MLT from DRcapsTM capsules filled with the MLT-loaded nanofibers reached 100% at 6h.

CONCLUSION

These findings suggest that the MLT-loaded nanofibrous mats developed in this study exhibit a promising profile for treating sleep dysfunctions.

Modified In Vitro Release of Melatonin Loaded in Nanofibrous Electrospun Mats Incorporated Into Monolayered and Three-Layered Tablets

Modified release tablet formulations with melatonin (MLT) are clinically more useful in initiating and maintaining sleep in elderly insomniacs, compared with those designed for immediate release. Aiming at the modified release of MLT, monolayered and 3-layered tablets, incorporating nanofibrous mats composed of cellulose acetate and polyvinylpyrrolidone loaded with MLT, were prepared and studied. In vitro dissolution profiles of MLT in gastrointestinal-like fluids revealed tableting pressure/pH-dependence. The release of the hormone from physical mixture tablets was generally slower from the nanofibers-based tablets, thus exhibiting in the latter case properties that are necessary for the control of both the sleep-onset and the maintenance dysfunctions. The nature of the excipients (hydroxypropylmethylcellulose or lactose monohydrate) used in this study to produce 3-layered tablets was also found to affect the release of MLT, adjusting it to the endogenous hormone's chronobiotic profile. The release of MLT from formulation F(nf)₂ (nanofiber mats incorporated into 3-layered tablets containing lactose monohydrate both in the upper and lower layers) was found to be in closer alignment with these effects than the other delivery systems.

Comparative In Vitro Controlled Release Studies on the Chronobiotic Hormone Melatonin from Cyclodextrins-Containing Matrices and Cyclodextrin: Melatonin Complexes

A series of hydrophilic matrix tablets was prepared and tested with respect to their ability to release the hormone melatonin in a controlled manner, in order to alleviate sleep onset and sleep maintenance dysfunctions. Besides the active ingredient, the tablets were comprised of combinations of the following: HPMC K 15M, low viscosity sodium alginate, microcrystalline cellulose (Avicel PH 102), magnesium stearate, and the cyclodextrins, α-CD, β-CD, γ-CD, HP-β-CD, sulfated β-CD, HP-α-CD and HP-γ-CD, and MLT (guest):CD (host) complexes of the above cyclodextrins, in 1:1 ratio. The controlled release studies were conducted in two aqueous dissolution media at pH 1.2 and 7.4. The stoichiometry of the formed complexes was examined by applying the continuous variation method (Job plot), while the stability constants were calculated by monitoring the spectrophotometric properties of free and CD-encapsulated melatonin (UV-Vis). Host-guest interactions were studied by Nuclear Magnetic Resonance (NMR) spectroscopy. The dissolution data suggest that melatonin is released faster from the MLT:CD complexes than from the rest matrix systems. This enhancement in the dissolution rate and the % release of melatonin from the complexes is due to the increased solubility of the MLT:CD complexes.

In vitro Controlled Release of two new Tuberculocidal Adamantane Aminoethers from Solid Pharmaceutical Formulations (II)

The aim of the present investigation was to develop matrix tablet formulations for the in vitro controlled release of two new tuberculocidal adamantane aminoethers (compounds III and IV), congeneric to the adamantane derivative SQ109, which is in final clinical trials, and aminoethers (I) and (II), using carefully selected excipients, such as polyvinylpyrrolidone, sodium alginate and lactose. The tablets were prepared using the direct compression method and dissolution experiments were conducted using the US Pharmacopoeia type II apparatus (paddle method) in gastric and intestinal fluids. The results suggest that both analogues, albeit more lipophilic than SQ109, and aminoethers (I) and (II), have the requisite in vitro release characteristics for oral administration. In conclusion, these formulations merit further assessment by conducting in vivo studies, at a later stage.

In vitro Controlled Release from Solid Pharmaceutical Formulations of two new Adamantane Aminoethers with Antitubercular Activity (I)

The aim of the present investigation was to develop matrix tablet formulations for the in vitro controlled release of 2 new tuberculocidal adamantane aminoethers (compounds I and II), congeneric to the adamantane derivative SQ109, which is in final clinical trials, using carefully selected excipients, such as polyvinylpyrrolidone, sodium alginate and lactose. The tablets were prepared using the direct compression method and dissolution experiments were conducted using the US Pharmacopoeia type II apparatus (paddle method) in gastric and intestinal fluids. The results confirm that both analogues, albeit more lipophilic than SQ109, showed satisfactory in vitro release characteristics from solid pharmaceutical formulations. In conclusion, these formulations merit further assessment by conducting in the future bioavailability in vivo studies.

Swelling Properties of Various Polymers Used in Controlled Release Systems

The effect of powder packing and porosity of specimens on the swelling properties of polymeric materials was studied, in various swelling liquids, such as distilled water and 0.1 N hydrochloric acid solution. Capsules, tablets and films of hydroxypropyl methylcellulose, poly(ethylene oxide) and sodium alginate were prepared, and their weight uptake after immersion into the above solutions was recorded as a function of time, in order to assess the swelling process. Measurements of some characteristics of the as-received powders were also performed in an attempt to classify the specimens prepared according to their porosity.

Within the experimental conditions of this work, it was shown that the porosity of polymeric specimens is a dominant factor that controls their swelling behaviour. Increased porosity leads to fast initial rates of weight uptake and high extent of equilibrium swelling. On the other hand, dissolution and possible degradation of polymers susceptible to acid hydrolysis results in some variations from the above mentioned behaviour.

With respect to the application in controlled release systems, theoverall delivery rate from a polymeric specimen is expected to be a function of both swelling and disintegration characteristics of a specimen, and therefore, the weight uptake can be considered a measure of the release only in the case of polymers with low water solubility and increased stability to hydrolysis.

Polymers for Use in Controlled Release Systems: The Effect of Surfactants on their Swelling Properties

The effect of an ampholytic surfactant on the swelling properties of polymeric materials was studied, using various swelling liquids. Tablets were prepared consisting of hydroxypropyl methylcellulose, poly(oxyethylene) and sodium alginate. Tego betain was the non-ionic surfactant used as an additive in a series of samples made of the above polymers. Those tablets were immersed in distilled water, phosphate buffer and 0.1 N HCl, and their weight uptake was recorded as a function of time, in order to assess the swelling process. Measurements of the contact angle of the above systems were also carried out for estimating their wetting properties.

The results of this study showed a selectivity among polymers, surfactant and surrounding liquid. Clearly, an enhancement of the swelling capacity of hydroxypropyl methylcellulose tablets due to the surfactant was recorded. An unclear effect was observed in the case of poly(oxyethylene), whereas for sodium alginate, the dominant factor is its water solubility that controls swelling behaviour.

Comparative evaluation of xenobiotics in human and dietary milk: persistent organic pollutants and mycotoxins

Publications produced over the past 20 years regarding the concentration of xenobiotics in human and dietary milk were evaluated, focusing primarily on persistent organic pollutants (e.g. polychlorinated biphenyls, flame retardants), pesticides (e.g organochlorine) and mycotoxins. In general, countries of low industrialization rate present low levels of dietary milk contamination with dioxins compared to those with high rate of industrialization. According to published data, the most common persistent organic pollutants detected in breast and dietary milk are dichlorodiphenyltrichloroethane compounds, hexachlorocyclohexane, and hexachlorobenzene. Even though the potential risks of persistent organic pollutants in human milk have been acknowledged, the beneficial effect of breastfeeding as the optimal food source for newborn babies should not be disregarded. Especially when sharing information with the general public, it should be made clear that the presence of dioxins and persistent organic pollutants in human milk is not an indication for avoiding breastfeeding. The implications of xenobiotics in human and dietary milk is a matter of growing importance and warrants future work given its important health effects.

Conformational analysis of two novel cytotoxic C2-substituted pyrrolo[2,3-f]quinolines in aqueous media, organic solvents, membrane bilayers and at the putative active site

We have performed: (i) conformational analysis of two novel cytotoxic C2-substituted pyrrolo[2,3-f]quinolines 5e and 5g in deuterated dimethylsulfoxide (DMSO-d(6)) utilizing NOE results from NMR spectroscopy; (ii) molecular dynamics (MD) calculations in water, DMSO and dimyristoyl phosphatidylcholine bilayers and (iii) molecular docking and MD calculations on DNA nucleotide sequences. The obtained results for the two similar in structure molecules showed differences in: (i) their conformational properties in silico and in media that reasonably simulate the biological environment; (ii) the way they are incorporated into the lipid bilayers and therefore their diffusion ability and (iii) molecular docking capacity as it is depicted from their different binding scores.

Utilization of hydrophilic swellable polymers as carriers for sustained drug delivery from matrices and three layer tablet systems

The purpose of this research was to develop and evaluate different sustained release preparations, using swellable polymers as carriers in the form of matrices and three-layer tablets. These preparations may offer a number of therapeutic advantages over immediate release dosage forms in drug delivery. The materials used for the fabrication of these systems were hydrophilic swellable polymers namely Metolose, Polyox, Xanthan gum and an erodible material Gantrez, acting as drug(diclofenac sodium) carriers. The powder characteristics determined for these polymers suggest good flowability with the exception of Gantrez. The addition of 1% of magnesium stearate resulted in improved flow properties for all polymers including Gantrez. Tablets were prepared by direct compression whereas three-layer tablets were prepared by compressing polymer barrier layers on both sides of the core containing the drug. Our findings show that both preparations exhibit sustained release characteristics; also the structure of the device considerably affects the drug release and the release rate. Furthermore erosion and swelling greatly influence the overall behavior, function and performance of the systems. Finally kinetic analysis studies indicated that the drug release mechanisms were also affected by these effects.

Dimensional changes, gel layer evolution and drug release studies in hydrophilic matrices loaded with drugs of different solubility

The objective of this investigation was to explore the effects of drug solubility on the evolution of matrix dimensions and gel layer's during drug release and investigate the relationship between these effects and the mechanism and the rate of drug release. Two hydrophilic swellable polymers Polyox (POL) and cross-linked Carbopol (CARB) were employed as carriers. Caffeine (CAF) and theophylline (THE), two drugs having similar chemical structure but different aqueous solubility, were used as model drugs. Both drug and polymer characteristics were found to influence the dimensional changes of matrices and the development of the gel layer formed around the glassy core. The dimensional expansion in CAF matrices was always more pronounced than the THE matrices. Also the CARB matrices demonstrated greater maximum expansion and lower drug release than the POL matrices, due to a smaller degree of erosion of CARB. The dimensions of CARB/CAF matrices, unlike all the other matrices studied, exhibited a biphasic increase at early times, which was attributed to the cross-linked structure of CARB and the high solubility of CAF. With both polymers, a thinner gel layer was developed in the matrices containing the less soluble THE compared to the CAF matrices. The thickness of the gel layer increased continuously with time in the CAF matrices whereas it increased initially and after reaching a maximum started to decrease in THE matrices. All formulations except those of CARB/THE exhibited burst release, which depended on drug and polymer characteristics. The gel layer thickness and erosion rate appeared to determine the rate of drug release from the CARB and POL formulations. The results clearly indicate that for these matrices gel thickness and fluctuation of gel thickness affect the release rate/h of drug proportionally. Analysis of the release kinetics indicated that CAF was released mainly through diffusion whereas, THE was released mainly through matrix erosion.

Controlled release of the pineal hormone melatonin from hydroxypropylmethylcellulose/sodium alginate matrices in aqueous media containing dioctyl sulfosuccinate

An investigation of the controlled release profile of mono-layered formulations of the hormone melatonin in modified aqueous media is described. The tablets used were comprised of hydroxypropylmethylcellulose (HPMC K15M) and sodium alginate with melatonin (fully soluble in the dioctyl sulfosuccinate (DSS) containing simulated intestinal solution). Three different sets of tablets (diameters 7.5, 10.0 and 13.0 mm) were tested with respect to the influence of their sizes on the hormone's release; the general trend observed was that tablets with larger surface area values had lower % release. A decrease in the value of W(o), obtained from the ratio [H(2)O]/[DSS], results to the predominance of DSS conformers in the aqueous media, which are less likely to solubilize melatonin effectively.