MA-5 ameliorates autism-like behavior in mice prenatally exposed to valproic acid

Indole-3-acetic acid is a common naturally occurring auxin in plants. A synthesized derivative of this compound, 4-(2,4-difluorophenyl)-2-(1H-indol-3-yl)-4-oxobutanoic acid also called mitochonic acid 5 (MA-5), has shown to increase the survival ratio of fibroblasts from patients with mitochondrial disease under stress-induced conditions. Further studies verified its efficacy in pathological models, such as an ischemia-reperfusion model, possibly by increasing ATP production. However, the efficacy of MA-5 in mental disorders, such as anxiety, schizophrenia, and autism spectrum disorders (ASD), has not been investigated. Our study focused on examining the effect of MA-5 in a mouse model of ASD induced by prenatal exposure to valproic acid (VPA). VPA exposure significantly deteriorated the level of anxiety and exploratory behavior in an open field test. We fed mice an MA-5-containing diet for 5 weeks and observed an improvement in the above behavior in the MA-5-fed groups. The efficacy of MA-5 was also observed in the elevated plus maze and three-chambered tests. These findings suggest that MA-5 could potentially be used to treat ASD, especially in patients with mitochondrial dysfunction.

Effect of ACAT inhibition on the progression of coronary atherosclerosis

BACKGROUND

The enzyme acyl-coenzyme A:cholesterol acyltransferase (ACAT) esterifies cholesterol in a variety of tissues. In some animal models, ACAT inhibitors have antiatherosclerotic effects.

METHODS

We performed intravascular ultrasonography in 408 patients with angiographically documented coronary disease. All patients received usual care for secondary prevention, including statins, if indicated. Patients were randomly assigned to receive the ACAT inhibitor pactimibe (100 mg per day) or matching placebo. Ultrasonography was repeated after 18 months to measure the progression of atherosclerosis.

RESULTS

The primary efficacy variable analyzing the progression of atherosclerosis--the change in percent atheroma volume--was similar in the pactimibe and placebo groups (0.69 percent and 0.59 percent, respectively; P=0.77). However, both secondary efficacy variables assessed by means of intravascular ultrasonography showed unfavorable effects of pactimibe treatment. As compared with baseline values, the normalized total atheroma volume showed significant regression in the placebo group (-5.6 mm3, P=0.001) but not in the pactimibe group (-1.3 mm3, P=0.39; P=0.03 for the comparison between groups). The atheroma volume in the most diseased 10-mm subsegment regressed by 3.2 mm3 in the placebo group, as compared with a decrease of 1.3 mm3 in the pactimibe group (P=0.01). The combined incidence of adverse cardiovascular outcomes was similar in the two groups (P=0.53).

CONCLUSIONS

For patients with coronary disease, treatment with an ACAT inhibitor did not improve the primary efficacy variable (percent atheroma volume) and adversely affected two major secondary efficacy measures assessed by intravascular ultrasonography. ACAT inhibition is not an effective strategy for limiting atherosclerosis and may promote atherogenesis. (ClinicalTrials.gov number, NCT00268515.).

[Sports-induced acute epicondylitis of the elbow and conservative therapy]

48 patients with an acute lateral and/or medial epicondylitis of the elbow, induced by sporting activities, were treated in a prospective, controlled, double-blind, and randomised clinical study over a period of one to two weeks in a standard manner, either with taping and the oral NSAID proglumetacine b.i.d. (26 patients: 8 women, 18 men; mean age of 37.8 years) or with taping and an oral placebo b.i.d. (22 patients: 11 women, 11 men; mean age of 40.0 years). The course of complaints was followed on the basis of a functional index (created according to Lequesne). Taking into account the prior definition of efficacy, at the end of the 1st week of all 22 NSAID group patients, enrolled and treated according to the protocol, there were already 21 responders and of all 19 corresponding placebo group patients, there were 12 responders. The difference is statistically significant (p = 0.0157). The rate of efficacy was 95.5% in the verum (plus taping) group and 63.2% in the placebo (plus taping) group with a further amelioration in both groups at the end of the study. Safety was comparably good in both the verum as well as the placebo group.

Double-blind, parallel-group evaluation of etodolac and naproxen in patients with acute sports injuries

The efficacy and safety of etodolac and naproxen were compared in a double-blind, randomized, parallel-group outpatient study. Patients with acute sports injuries were assigned to receive either etodolac 300 mg TID (50 patients) or naproxen 500 mg BID (49 patients) for up to 7 days. Assessments were made at the pretreatment screening (baseline) and at days 2, 3, 4, and 7 of treatment. Assessments included patient and physician global evaluations, spontaneous and induced pain intensity, range of motion, tenderness, heat, degree of swelling, and degree of erythema. Safety assessments, including laboratory profiles, were made at pretreatment and at final evaluation; patients' complaints were elicited at all visits. Both treatment groups showed significant (P less than or equal to 0.05) improvement from baseline for all efficacy parameters by day 2 and thereafter at all time points. Improvement was similar for the two groups. No patients in either group withdrew from the study because of drug-related adverse reactions. The results of this study indicate that etodolac (900 mg/day) is effective and well tolerated as an analgesic and anti-inflammatory in acute sports injuries and is comparable to naproxen (1000 mg/day).

Possible mechanisms of gastroduodenal mucosal damage in volunteers treated with nonsteroidal antiinflammatory drugs--the usefulness of prodrugs

A controlled double blind study on the incidence of nonsteroidal antiinflammatory drug (NSAID) gastropathy was performed in 29 healthy volunteers administered diclofenac Na (10 subjects) or a prodrug (loxoprofen Na in 10 subjects and proglumetacin maleate in 9 subjects). The incidence of NSAID gastropathy was significantly lower in the subjects administered the prodrugs than in those administered diclofenac Na (p less than 0.05), which suggested the clinical usefulness of the prodrugs.

Safety and efficacy of etodolac compared with piroxicam in patients with degenerative joint disease of the knee

The efficacy and safety of etodolac and piroxicam were compared in a double-blind, randomized, parallel-group outpatient study at four sites. Patients with active osteoarthritis of the knee were assigned to receive etodolac 600 mg/day (57 patients) or piroxicam 20 mg/day (59 patients) for 6 weeks. Efficacy assessments were made at the pretreatment screening, at baseline, and at treatment weeks 2, 4, and 6 for patient and physician global evaluations, night pain, spontaneous pain intensity, weight-bearing pain variables, measures of inflammation, morning stiffness, and knee flexion. An analysis was also done based on each patient's final evaluation, regardless of the week at which it occurred. Safety assessments were made before treatment and at the completion of therapy. A therapeutic response was obtained in both treatment groups by the end of the second week of treatment. At the final evaluation, both groups showed significant improvement (P less than or equal to 0.05) from baseline for most efficacy assessments. The physician's global assessment indicated improvement in the condition of 60% of the etodolac-treated patients and 39% of the piroxicam-treated patients at the final evaluation. There was no significant difference between treatment groups in the number of patient withdrawals due to adverse reactions or in the number of patients reporting side effects. The results of this study indicate that, compared with piroxicam 20 mg/day, etodolac 600 mg/day is effective and well tolerated in the treatment of patients with osteoarthritis.

Efficacy and tolerability comparison of etodolac and piroxicam in the treatment of patients with osteoarthritis of the knee

The efficacy and tolerability of etodolac and piroxicam were compared in patients with osteoarthritis of the knee. Two hundred and twenty patients entered a double-blind, parallel group trial and were randomly assigned to receive 300 mg etodolac twice daily (n = 112) or 20 mg piroxicam once daily (n = 108) for 8 weeks. The etodolac group showed significant improvement (p less than 0.05) from baseline in all efficacy assessments at all evaluations. The piroxicam group showed improvement from baseline in all efficacy assessments at all evaluations except for erythema at Week 2. While mean change from baseline was similar for both groups, the patients' and physicians' final overall evaluations showed that the etodolac-treated patients improved slightly more from baseline than the piroxicam-treated patients. Twenty (18%) patients in the etodolac group reported at least one drug-related study event. In the piroxicam group, 16 (15%) patients reported at least one drug-related study event. Twelve (11%) etodolac-treated patients prematurely withdrew from the study. Of these, 7 had at least one adverse reaction. Two of the 12 patients withdrew because of lack of efficacy. Withdrawals from the piroxicam group were comparable. Thirteen (12%) patients withdrew, 6 of whom had at least one adverse reaction. One of these patients suffered a cardiovascular accident and died. Three patients withdrew because of lack of efficacy. The results of this study indicate that etodolac and piroxicam are comparable in efficacy and tolerability for the treatment of patients with osteoarthritis.

A double-blind gastroscopic evaluation of the effects of etodolac and naproxen on the gastrointestinal mucosa of rheumatic patients

The aim of this clinical, endoscopical study was to evaluate the therapeutic efficacy and the gastric tolerability of etodolac, a new anti-inflammatory, non-steroidal drug, compared with naproxen. The study was conducted on 48 patients suffering from rheumatoid arthritis. 44 of whom completed the trial. After an initial oesophagogastroduodenoscopy to exclude the presence of gastric mucosal lesions, patients were randomly allocated to double-blind treatment with either etodolac 200 mg b.i.d. or naproxen 500 mg b.i.d. for a period of 4 weeks. Endoscopic control followed this treatment period. Both drugs proved effective in relieving clinical symptoms, without a statistically significant difference. Gastric mucosal lesions were observed in 15% of etodolac-treated patients and in 46% of patients treated with naproxen (P less than 0.05) (95% CI 0.01-0.60). Painful dyspepsia was observed in 15% of patients treated with etodolac vs. 38% of patients on naproxen therapy. This study demonstrates that etodolac is at least as active as naproxen in relieving rheumatic symptoms, and its administration results in a significantly lower degree of gastric damage.

Double-blind comparison of etodolac and piroxicam in patients with rheumatoid arthritis

A study was carried out to compare the efficacy and tolerability of etodolac and piroxicam in patients with rheumatoid arthritis. Sixty patients entered this double-blind, parallel study and after a wash-out period of up to 2 weeks were randomly assigned to receive 200 mg etodolac twice daily or 20 mg piroxicam once daily for 12 weeks. Efficacy and tolerability assessments were made after 2, 4, 6, 8 and 12 weeks. Patients in the etodolac group demonstrated statistically significant improvement in the number of tender joints and the duration of morning stiffness after 12 weeks, as did the piroxicam-treated patients. In addition, the etodolac-treated patients had significant improvement according to the patients' and physician's global evaluations, pain intensity, number of swollen joints, and grip strength. There were significant differences between therapies favouring etodolac for the assessments of the number of tender joints and the physician's global evaluation by the end of the study. Forty-seven percent (47%) of 15 etodolac-treated patients compared with 7% of 15 piroxicam-treated patients showed improvement according to the physician's global evaluation at Week 12. Similarly, the patients' global evaluation showed that 40% of etodolac-treated patients and 19% of piroxicam-treated patients had improved by the end of therapy. Both therapies were well tolerated. There were no significant differences between groups in the incidence of any adverse reactions or the frequency of withdrawals.

Global safety of etodolac: reports from worldwide postmarketing surveillance studies

Etodolac is a new nonsteroidal anti-inflammatory drug (NSAID) that has shown a favorable safety profile in clinical trials in osteoarthritis (OA) and rheumatoid arthritis (RA). Four postmarketing surveillance studies were conducted with patients who had OA and RA to further assess the safety of etodolac. One study also had patients with ankylosing spondylitis (AKS). These studies were conducted in Italy, Switzerland, the United Kingdom, and France. A total of 8334 patients received oral doses of 200 to 600 mg/day for periods ranging from 4 weeks to 1 year. The incidence of study events was low, 77% of the patients treated in these postmarketing surveillance studies reported no study events. Only 9% of all the patients treated withdrew from these studies because of adverse effects. Gastrointestinal events were the most commonly reported among the study events that did occur, as expected for an NSAID. These results further support the safety of etodolac that was previously established in clinical trials.

Large-scale open trials with etodolac (Lodine) in France: an assessment of safety

Two large-scale open-label studies were performed in France to confirm the efficacy and safety of etodolac (Lodine), a new non-steroidal anti-inflammatory drug (NSAID). Study I, a 6-week study performed by 974 rheumatologists, involved 4947 patients who had rheumatoid arthritis (RA), ankylosing spondylitis (AS), or osteoarthritis (OA). Both efficacy and safety were assessed. Study II, a postmarketing safety study performed by approximately 9000 general practitioners, involved 51,355 patients who had rheumatic conditions requiring therapy with NSAIDs. The daily dose of etodolac ranged from 200 to 600 mg/day in these studies, depending on the protocol and patient response. By the end of study I (visit 3), spontaneous pain improved by 33% for patients with RA, by 42% for patients with AS, and by 50% for OA patients. A total of 1276 adverse reactions (AR) were reported during the study, and fewer than half of these were related to study treatment. Only 6 severe reactions were reported; three of these were considered unrelated to study treatment, including 2 deaths. In study II, 10.1% of patients reported 6236 ARs and 9.0% of patients dropped out because of AR. Twenty-one of the ARs reported in study II were judged severe, and all of these patients recovered completely. The overall opinion of safety was assessed as very good or good by 89% of patients. In both studies (greater than 55,000 patients), 11% of patients reported an AR, and severe reactions were rare. These results confirmed the very acceptable risk/benefit ratio of etodolac and rank this drug high for efficacy and safety among the NSAIDs recently introduced in France.

[Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?]

Thirty cases of clometacin-induced hepatitis were retrospectively collected over a nine-year period in hepatogastroenterological units of non university, public hospitals. There was a strong female predominance (90 percent). Clometacin (Dupéran) was taken because of arthritis in 8 out of 10 cases. Administration was continuous in 85 percent of cases and median duration was 445 days. median dose was 450 mg per day. Jaundice, fatigue, and weight loss were the most frequent symptoms, but edema, ascites and palmar erythema were not uncommon. Thrombopenia (38 percent) was the most frequent hematologic abnormality. Renal failure, always with benign course, was present in 1/4 of cases. Biochemical disorders indicated hepatocellular and cholestatic hepatitis in 3/4 and 1/4 of cases respectively. Hypoprothrombinemia below 50 percent was noted in 1 out of 6 cases, and was associated with death in half cases. Gamma-globulins were increased in 80 percent of cases, with a predominant increase of IgG. Antinuclear or anti-smooth muscle antibodies were present in 60 percent of cases, whereas antimitochondrial and antimicrosomes were absent. Histopathological examination of the liver biopsy specimens obtained in 25 patients showed acute hepatitis in 8 and chronic active hepatitis with fibrosis in 17--including 6 patients with cirrhosis; there were no epidemiological, clinical (except ascites), or biochemical differences between these two groups. Four of the 7 patients tested had HLA B8 antigens; they all had chronic active hepatitis, with autoantibodies in 3 cases. Median duration of hospitalization was 21 days. Hepatitis was directly responsible for death in 3 patients; biochemical sequelae (hypergammaglobulinemia or anicteric cholestasis) were present in 8 patients, 2 of whom most likely had cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the efficacy and comparative effects on gastric and duodenal mucosa of etodolac and naproxen in patients with rheumatoid arthritis using endoscopy

The therapeutic efficacy and upper gastrointestinal side effects of a twice daily dose of 300 mg etodolac and 500 mg naproxen were compared in 30 hospital out-patients with active rheumatoid arthritis. Drugs were taken for 4 weeks in a double-blind, randomized, parallel group, single centre study. Rheumatological, endoscopic and laboratory assessments were performed at the start and on completion of the study. Mucosal lesions developed in only three (20%) patients of the etodolac group and they all had low endoscopy scores, compared to eight (53%) patients of the naproxen group with significantly worse endoscopy scores (p less than 0.05). Lesions were asymptomatic in all but one patient (on naproxen), and the gastric antrum was the commonest region involved. Of the 11 patients who developed endoscopic abnormalities in both groups, seven (64%) were moderate to heavy smokers. Etodolac had a similar antiarthritic effect to naproxen, but it appears to be better tolerated by the upper gastrointestinal mucosa as shown by endoscopy.

[Efficacy, tolerability and therapeutic benefit of etodolac (Lodine 200) in rheumatologic practice]

Efficacy, safety and therapeutic benefit of etodolac (Lodine 200) in rheumatological practice. An open clinical trial performed by 974 rheumatologists enabled an evaluation of efficacy, safety and therapeutic benefit of etodolac (Lodine 200) on 4,947 patients with rheumatoid arthritis, ankylosing spondylitis and osteoarthritis of the lower limbs; the initial dosage was 600 mg/d (for 2 weeks), then 400 to 600 mg/d (for 2 to 4 weeks, according to the indication). Efficacy, assessed by classical items for NSAID's, was shown to be excellent to good by 61-77 p. 100 of patients, according to the indication. 7.7 p. 100 of patients only dropped out for lack of efficacy. 20.4 p. 100 of patients developed adverse effect(s) (AE), but the relationship between etodolac and AE was assessed "possible" or "probable" only for 9.6 p. 100 of patients; this figure should be compared to the 7.6 p. 100 of patients who dropped out for AE and to the 92 p. 100 of patients who assessed the global safety as "excellent or good". The therapeutic benefit was estimated very favorable: 75 p. 100 of patients felt better than at the beginning of the study, 64.5 p. 100 of patients wished to continue the treatment and the (mean) benefit-risk ratio assessed with a logarithm scale (-1 to +1), ranged from 0.45 to 0.6 according to the indication. Therefore, this trial confirmed the good efficacy and safety profile of etodolac on a large scale in normal clinical practice in France, following assessments during controlled trials. It also permitted to perfect new items of evaluation for NSAID's, in particular for therapeutic benefit.

Theoretical mechanism for the gastrointestinal safety of etodolac: selective sparing of cytoprotective prostaglandins

The high concentrations of pro-inflammatory prostaglandins (PGs) produced in the joint during the initial stage of inflammation can be decreased by inhibiting their biosynthesis with nonsteroidal anti-inflammatory drugs (NSAIDs). The commonly encountered gastrointestinal intolerance in human subjects treated with NSAIDs is generally attributed to inhibition of PG synthesis in gastric mucosa, where the natural role of locally biosynthesized PGs is to protect the mucosa from necrosis upon exposure to noxious agents. The action of an ideal NSAID should therefore be tissue specific, i.e., it should inhibit PG formation at the sites of inflammation but not in gastric mucosa, where PGs are needed for cytoprotection. We believe that etodolac, a new, structurally distinct NSAID, meets this criterion, inhibiting PG synthesis in a tissue-specific fashion. Experimental data supporting this interpretation were obtained in rats by demonstrating that daily administration of orally effective anti-inflammatory doses of etodolac had no significant effect on gastric mucosal PGE2 or prostacyclin levels (measured as the stable metabolite, 6-keto-PGF1 alpha). In contrast, naproxen, piroxicam, and aspirin caused a statistically significant PG depletion. The results obtained in rats thus support the view that the favorable gastrointestinal safety profile of etodolac in human patients may be attributable to selective sparing of the cytoprotective PGs in gastric mucosa.

Etodolac, a new nonsteroidal anti-inflammatory drug: gastrointestinal microbleeding and endoscopic studies

A review of the literature is presented on the gastrointestinal effects of etodolac, a new nonsteroidal anti-inflammatory drug (NSAID), as evaluated in both microbleeding and endoscopic studies. In four microbleeding studies, gastrointestinal blood loss in healthy subjects was estimated by a 51Cr-erythrocyte labeling method before drug treatment, after 7 days of treatment with NSAIDs including etodolac, and 1 week after the last day of treatment. In these 7-day studies, the gastrointestinal blood loss seen with etodolac (600 to 1200 mg/day) was similar to that seen with placebo and significantly (p less than 0.05) less than that seen with aspirin (2600 mg/day), naproxen (750 mg/day), ibuprofen (2400 mg/day), or indomethacin (200 mg/day). Naproxen, ibuprofen, and indomethacin caused mean daily blood losses in excess of 1 ml/day over baseline values. The increase with aspirin was 4 to 5 ml/day. In contrast, the greatest mean daily increase in blood loss with etodolac therapy was 0.2 ml. In a 4-week study of etodolac (600 and 1000 mg/day) and piroxicam (20 mg/day) given to patients with osteoarthritis or rheumatoid arthritis, blood loss seen with etodolac was comparable to that seen with placebo and significantly less than that seen with piroxicam. Gastrointestinal irritation was also assessed by endoscopy after 1 week of NSAID or placebo treatment. Endoscopy scores after etodolac treatment (up to 1200 mg/day) were similar to scores at baseline and after placebo and were significantly lower than scores following treatment with aspirin (3900 mg/day), indomethacin (200 mg/day), ibuprofen (2400 mg/day), or naproxen (100 mg/day). The effects of etodolac (600 or 1000 mg/day) and diclofenac (150 mg/day) were not different from each other or from baseline. These data indicate that etodolac, in these studies, did not cause clinically significant gastrointestinal microbleeding or visible gastric injury. By the criteria used in these studies, etodolac is less irritating to the gastrointestinal tract than aspirin, indomethacin, ibuprofen, naproxen, or piroxicam, and compares favorably with diclofenac.

A review of the antiarthritic efficacy and safety of etodolac

Etodolac (Lodine, Ramodar, Ultradol), an anti-inflammatory, analgesic agent, is the first of a new class of nonsteroidal anti-inflammatory drugs (NSAIDs), the pyranocarboxylic acids. A review of the literature on numerous clinical studies showed that etodolac (200 to 600 mg/day) is effective in the treatment of osteoarthritis and rheumatoid arthritis. Etodolac has also been shown to be very well tolerated. In double-blind studies, there were no significant differences in the incidences of new patient complaints except for indigestion between etodolac-treated groups and placebo-treated groups. Gastrointestinal microbleeding associated with etodolac was comparable to that with placebo and was significantly less than that associated with other commonly used NSAIDs, such as ibuprofen, indomethacin, piroxicam, and naproxen. The results of laboratory tests, including a detailed analysis of hepatic and renal function, have revealed few abnormalities, most of which were clinically unimportant. When administered to healthy subjects, etodolac had no pharmacokinetic interactions with three other drugs that are highly bound to serum protein: warfarin, glyburide, and phenytoin.

A global safety evaluation of etodolac

Etodolac has previously been reported to have an excellent safety profile. Results of recent clinical trials and of a clinical practice study were compared with the previously reported safety data for etodolac. The total incidence of patient complaints and of laboratory abnormalities continues to be low, with no apparent increase in side effects with increasing patient age. In the clinical practice study, 60% of study events occurred early in therapy (before 10 weeks). These data support an excellent safety profile for etodolac.

Etodolac therapy for osteoarthritis: a double-blind, placebo-controlled trial

The efficacy of etodolac (600 mg/day) and placebo were compared in a 4-week double-blind, parallel-group study involving 104 patients with osteoarthritis of the knee and 106 with osteoarthritis of the hip. Most patients had improvement of their symptoms during the study, but significantly more improvement was seen in the patients taking etodolac. Patients with osteoarthritis of the knee taking etodolac had significantly (p less than 0.05) more improvement than placebo-treated patients in joint swelling, weight-bearing pain, and patient's overall assessment. Patients with osteoarthritis of the hip taking etodolac had significantly (p less than 0.05) greater improvement than placebo-treated patients in hip abduction, weight-bearing pain, joint tenderness, investigator's overall assessment, and patient's overall assessment. The frequency of adverse events was not statistically different in the two treatment groups. However, significantly (p = 0.05) more etodolac-treated patients (n = 9) than placebo-treated patients (n = 2) reported indigestion. The incidence of adverse events was similar in patients aged 65 years and older to that in patients younger than 65 years. Results of laboratory evaluations indicated that etodolac therapy was associated with no more hepatic or renal enzyme abnormalities than was placebo.

Characteristics of clometacin-induced hepatitis with special reference to the presence of anti-actin cable antibodies

The clinical, biochemical, histopathological and immunological features of 30 cases of clometacin-induced hepatitis are described. The age range of the patients was 32-84 years with a notable female predominance of 29:1. The hepatitis was highly cytolytic with high values of transaminases but with little or no cholestasis. Gammaglobulins were higher than 18 g/l in 73% of the cases. 25 liver biopsies were performed and showed acute hepatitis with a predominant centrilobular necrosis in 17; chronic aggressive hepatitis was noted in 8 cases but 1 showed concomitant cirrhotic changes. Anti-tissue antibodies were looked for in all cases. Anti-smooth muscle antibodies of anti-actin cable type (titre 1/80 to 1/2, 560) were detected in 19 cases, anti-nucleus antibodies in 16 cases which were associated to the former in 14 cases. The above findings show that clometacin produces a hepatitis syndrome quite akin to autoimmune chronic active hepatitis (lupoid hepatitis) and to the hepatopathy induced by oxyphenisatin.

Efficacy and tolerability of etodolac in the treatment of osteoarthritis

An open clinical trial was carried out in 57 patients with osteoarthritis of the knee, hip or spine to assess the effectiveness and tolerability of etodolac. Patients received 200 mg etodolac twice daily for a period of 2 weeks. The results of clinical and patient assessments made at baseline and at the end of the study period showed that there was significant improvement in pain at rest and on active and passive movement, local tenderness, pain on climbing stairs, joint swelling and functional status. No significant changes were seen in clinical severity of the condition or, in patients with osteoarthritis of the knee, in the degree of knee flexion. Patients judged the therapeutic results to be good or excellent more often than the investigator (75% vs 50%). Tolerability of etodolac was very good with few, generally mild side-effects and only 2 patients were withdrawn, more as a precautionary measure than of necessity.

The role of the epidermis and cortex in gravitropic curvature of maize roots

In order to determine the role of the epidermis and cortex in gravitropic curvature of seedling roots of maize (Zea mays L. cv. Merit), the cortex on the two opposite flanks was removed from the meristem through the growing zone; gravitropic curvature was measured with the roots oriented horizontally with the cut flanks either on the upper and lower side, or on the lateral sides as a wound control. Curvature was slower in both these treatments (53 degrees in 5 h) than in intact roots (82 degrees), but there was no difference between the two orientations in extent and rate of curvature, nor in the latent time, showing that epidermis and cortex were not the site of action of the growth-regulating signal. The amount of cortex removed made no difference in the extent of curvature. Curvature was eliminated when the endodermis was damaged, raising the possibility that the endodermis or the stele-cortex interface controls gravitropic curvature in roots. The elongation rate of roots from which just the epidermis had been peeled was reduced by 0.01 mM auxin (indole-3-acetic acid) from 0.42 to 0.27 mm h-1, contradicting the hypothesis that only the epidermis responds to changes in auxin activity during gravistimulation. These observations indicate that gravitropic curvature in maize roots is not driven by differential cortical cell enlargement, and that movement of growth regulator(s) from the tip to the elongating zone is unlikely to occur in the cortex.

Plasma pharmacokinetics of cinmetacin following oral administration in healthy volunteers

The pharmacokinetics of a single 600 mg oral dose of 1-cinnamoyl-2-methyl-5-methoxy-3-indolylacetic acid (cinmetacin, Cindomet) was studied in 8 healthy volunteers of both sexes. Plasma levels of the drug were assayed by using an HPLC technique ad hoc devised. Following administration, the Cmax was reached at the 2nd h in 7 out of 8 subjects with an average value of 18.19 micrograms/ml; 12 h after the dose (last sampling time) appreciable plasma levels of cinmetacin were measured, corresponding to 17.2% of the maximum average concentration. The mean values +/- S.E. concerning the elimination half-life, the total volume of distribution, the total plasma clearance and the total area under the curve were 3.80 +/- 0.21 h, 0.28 +/- 0.03 l/kg, 0.051 +/- 0.005 l/kg/h, and 125.64 +/- 15.97 micrograms.h/ml, respectively. The plasma decay of cinmetacin was monophasic and the data were interpreted according to a one-compartment open model. Overall results indicate that cinmetacin is well and rapidly absorbed orally and widely distributed in body fluids.

[Immunopathological study of acute interstitial nephropathy induced by clometacin]

Clometacin is an antalgic drug with a chemical structure very similar to that of indomethacin; it is widely used in France. We report evidence for a cell-mediated immune mechanism in the pathogenesis of clometacin-induced acute interstitial nephritis. In the interstitial infiltrate of a female patient presenting with this condition, T cells constituted 75% of the total lymphocyte population. Cytotoxic/suppressor T cells predominated over helper/inducer T cells with a ratio of two to one. IgA-secreting plasmocytes were also present (about 23% of the inflammatory infiltrate). Peripheral blood lymphocyte studies showed that pre-incubation of the patient's cells with clometacin resulted in an increased sensitivity to interleukin 2 and a positive syngeneic mixed lymphocyte culture. This study seems to be relevant to the pathogenesis of acute interstitial nephritis induced by nonsteroidal anti-inflammatory drugs.

Drug-induced hepatitis associated with anticytoplasmic organelle autoantibodies

A study from five hepatology units documenting 157 cases of drug-induced hepatitis and a second study from a laboratory of immunology which tested more than 100,000 sera permitted us to establish the frequency of antiorganelle antibodies and their diagnostic value in drug-induced hepatitis. In drug-induced hepatitis caused by a heterogenous group of drugs consisting of ajmaline, aminopterine, isaxonine, isoniazid, perhexiline, phenylbutazone and troleandromycine, antiorganelle antibodies were absent or rare. In drug-induced hepatitis caused by another heterogenous group of drugs, including clometacin, fenofibrate, oxyphenisatin and papaverine, antismooth muscle, antinucleus and antimitochondria antibodies were found in isolation or in different combinations in 70% of cases. From the presence of antismooth muscle antibodies in sera, we could trace 30 cases of clometacin-induced hepatitis. The third group included drug-induced hepatitis with special antibody:iproniazid-induced hepatitis with antimitochondrial antibody 6 and tienilic acid (ticrynafen)-induced hepatitis with antiliver/kidney microsome antibody 2 (anti-LKM2). These two antibodies are rare in routine sera and were absent in patients who received the drug and had no liver damage. From the presence of corresponding antibodies, we detected six cases of iproniazid-induced hepatitis and 67 cases of tienilic acid-induced hepatitis. Antiorganelle antibodies found in high titers disappeared in 2 to 24 months following withdrawal of the offending drug. The fourth group was represented by halothane-induced hepatitis; antiliver/kidney microsome antibody 1 was weak and infrequent. Similarities between drug-induced hepatitis of the second group and lupoïd hepatitis suggest that drugs may reveal this spontaneous disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Antirheumatic medication during lactation

All nonsteroidal anti-inflammatory drugs (NSAIDs) and antirheumatic drugs are likely to be distributed into human milk to some extent; whether they are detected is a function of the assay sensitivity. For minimal infant exposure, the ideal drug for lactating women is one which has a short half-life, is found in minimal quantities in human milk and has inactive metabolites which also are present only in small amounts. In order to reduce the quantity of drug presented to the child, the drug should be taken by the mother at the time of breast-feeding with the next feed occurring after a time period equivalent to one half-life of the drug. Using the above-mentioned criteria, the choice of NSAIDs would be between a short half-life propionic acid derivative, with little biotransformation, such as ibuprofen or flurbiprofen. Diclofenac is also suitable. Gold salts and corticosteroids would seem safe to prescribe. However, the infant should be closely monitored if antimalarials are being used by lactating women.

[Chronic active hepatitis associated with anti-native DNA antibodies: incidence of drug etiology]

Of 75 patients with HBsAg negative chronic active hepatitis (CAH), 28 had antinuclear antibodies in their serum. We have tested these patients' sera for serum antibodies against double stranded (native) DNA (anti-ds-DNA), by immunofluorescence with Crithidia luciliae as substrate. They were found in 14 patients (50 p. 100). Thirteen of the patients with anti-ds-DNA and 11 of those without were female; the mean ages were 64 +/- 16 and 56 +/- 19 years, respectively. The clinical and biological signs seemed to be more severe in patients with anti-ds-DNA than in those without. Liver histological activity and frequency of cirrhosis (about 50 p. 100) were similar in patients with or without anti-ds-DNA. Ten of the 14 patients with anti-ds-DNA had been given hepatotoxic drugs whereas only 2 patients lacking these antibodies had taken a hepatotoxic drug (p less than 0.01). In subjects with anti-ds-DNA, clometacin was the most common hepatotoxic drug, taken alone in 5 patients or together with other hepatotoxic drugs in 3 subjects. Only 4 of the patients with anti-ds-DNA displayed symptoms of systemic lupus erythematosus and two of these subjects took a hepatotoxic drug. In our experience, serum anti-ds-DNA were frequently found in patients with CAH and antinuclear antibodies; in this group CAH was often associated with hepatotoxic drugs, especially clometacin. Thus, the presence of anti-ds-DNA in sera of patients with HBsAg negative CAH may be an indication of drug-induced liver damage.

[Proglumetacin for the treatment of inflammatory and degenerative arthropathies]

Twenty patients with inflammatory (15) or degenerative (5) joint disorders had been treated with 450 mg/day of proglumetacin during 35 +/- 18 days. Articular symptoms showed a definite and continued improvement, particularly evident during the initial 15 days of treatment on both painful and inflammatory components. The final physician's evaluation rated 75% of results as excellent or good, versus 15% of poor (3 patients, one of whom already refractory to diclofenac). The tolerance was defined as excellent to good in 90% of patients: one (5%) was dropped out upon the onset of sweating and palpitation, already observed with other drugs. Overall, only one case each of heartburn, anorexia and diarrhoea were considered as possibly related to the treatment. Laboratory tests did not show any variation that could be attributed to the drug. Proglumetacin therefore, by force of its efficacy and safety, appears to be particularly suited as a first-choice drug for the management of both inflammatory and degenerative joint disorders.

[Tolerance and efficacy of proglumetacine in patients with rheumatoid arthritis]

The efficacy of proglumetacin , a new non-steroidal antiinflammatory drug, was assessed in 32 patients with rheumatoid arthritis. During treatment with 400-650 mg daily of proglumetacin over a period of 7-14 days, morning stiffness and side-effects were checked weekly or in severely ill patients daily. All patients but one completed the period of treatment. In spite of the short period of observation, a significant improvement was seen in the majority of cases (55%), while in 39% proglumetacin was not more effective than treatments before the admission to the study. In the group of patients treated for 14 days, morning stiffness parameters showed a significant improvement after 7 days and at the end of the period of study. Overall , only 3 patients referred side-effects: 1 case of transient headache and 2 cases of severe gastric pain. In our preliminary study, proglumetacin results to be effective as an antiinflammatory drug also in severe rheumatoid arthritis and safe for its low incidence of side-effects.

[Acute renal failure and hepatitis induced by clometacin]

Various types of allergic accidents have been reported with clometacin (Duperan), a synthetic analgesic introduced in France in 1971. The most prominent is hepatitis in elderly women, with hyperglobulinemia, eosinophilia, autoantibodies and giant multinucleated hepatocytes. The case presented herein concerns a 73-year-old woman who, on two separate occasions after the ingestion of clometacin at recommended dosages, developed at the same time typical acute hepatitis and non-oliguric acute renal failure. The second episode came soon after the medication was inadvertently reintroduced. Both hepatic and renal involvements were fully reversible. A renal biopsy showed predominant lesions of acute interstitial nephritis and tubulonecrosis. Three possible mechanisms are discussed: 1) sensitivity of the kidney to drugs because of preceding angiosclerosis, 2) impaired regulation of renal blood flow because of clometacin provoked decrease of prostaglandin synthesis, and 3) as in the case of nephrotoxicity due to other medications, allergic mechanisms.

[Eosinophilic cystitis of allergic origin]

Eosinophilic cystitis, of which 35 cases have been published, is a recurrent cystitis remarkable for its chronicity and for the importance of haematuria; the urine is usually sterile and blood eosinophilia frequently present; at histology, infiltration of the vesical wall by eosinophils is pathognomonic. In view of the irregular results of cortico-steroid treatment, a search for causative factors is required. Parasitic infestation has been suspected but never actually proven, and an allergic origin probably is frequently missed. We report two cases of eosinophilic cystitis where allergy to penicillin and clometacin respectively could be demonstrated for the first time and in which the condition subsided after withdrawal of these drugs.

[Acute renal insufficiency with ketoprofen and clometacin]

Several recent reports emphasize the adverse effects of non-steroidal antiinflammatory drugs on renal function. These reports incriminate several phenylpropionates but none involve ketoprofen. There have been no indications that clometacin has renal toxicity. We report a case of acute renal failure which occurred during therapy with both ketoprofen and clometacin. The onset of renal failure after their administration, the return to normal renal function once therapy was discontinued and the absence of any other detectable etiology make the responsibility of the treatment very likely. The different possible mechanisms and the role of underlying disease and of associated therapy are discussed. In the index case the reduced excretion of urinary prostaglandin E2 suggests inhibition of prostaglandin synthesis rather than direct drug toxicity or an immuno-allergic mechanism.

[Reversible renal insufficiency due to clometacin treatment]

In a 74-year-old man with chronic renal failure, Clomethacine therapy was followed, on two different occasions, by transient exacerbation of renal failure. Once therapy was discontinued, serum creatinine levels returned to normal. The chronologic evidence and data from the literature confirm the responsibility of Clomethacine.