Expert review of clinical pharmacology
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Expert Rev Clin Pharmacol · Nov 2021
ReviewThe value of deprescribing in older adults with dementia: a narrative review.
Introduction:Mitigating the burden of unnecessary polypharmacy or multiple medication use in people living with dementia has been recognized as a key priority internationally. One approach to reducing inappropriate polypharmacy is through medication withdrawal or deprescribing. Area covered:Non-systematic searches of key databases including PubMed, Embase, and Google Scholar were conducted from inception to 28 February 2021 for articles that assessed the safety and/or efficacy of deprescribing in older adults living with dementia. ⋯ However, the current evidence is limited in scope as most studies focused on medication-related outcomes (e.g. discontinuation of high-risk medications) rather than patient-centered outcomes in individuals living with dementia. Furthermore, most studies focused on addressing inappropriate polypharmacy in older adults with dementia living in long-term care facilities, and interventions did not involve the person and their carer. Further evidence on the impact of deprescribing in this population across clinical settings is needed.
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Expert Rev Clin Pharmacol · Feb 2020
ReviewEmerging concepts on the use of ketamine for chronic pain.
Introduction: The use of ketamine infusions for chronic pain has surged, with utilization exceeding the proliferation of knowledge. A proposed mechanism for the long-term benefit in chronic pain is that ketamine may alter the affective-motivational component of pain. Areas covered: In this review, we discuss the classification and various dimensions of pain, and explore the effects of ketamine on different pain categories and components. ⋯ We also summarize animal models evaluating the antinociceptive effects of ketamine and risk mitigation strategies of ketamine-associated side effects. Expert opinion: Although ketamine exerts most of its analgesic effects via the NMDA receptor, recent evidence suggests that other receptors such as AMPA, and active metabolites such as nor-ketamine, may also play a role in pain relief and alleviation of depression. Data from clinical studies performed in patients with chronic pain and depression, and the observation that ketamine's analgesic benefits outlast its effects on quantitative sensory testing, suggest that the enduring effects on chronic pain may be predominantly due ketamine's ability to modulate the affective-motivational dimension of pain.
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Expert Rev Clin Pharmacol · Sep 2020
ReviewDevelopment and progress of clinical trials of Coronavirus Disease 2019 antiviral drugs.
We have summarized and analyzed the clinical trial registration status and the latest research progress of eight major antiviral drugs during the epidemic of Coronavirus Disease 2019 (COVID-19), which can provide reference methods for clinical formulation of the best antiviral treatment. ⋯ The registration system of clinical trials and the level of clinical trial design need to be further improved. At present, no specific drug has been found for the treatment of COVID-19, the efficacy of antiviral drugs mostly comes from small sample studies or retrospective studies, and the level of clinical evidence is low. Besides, multi-drug combination therapy may become a more effective treatment choice, but the drug interactions and adverse drug reactions also need to be closely monitored. In summary, the safety and efficacy of various antiviral drugs need to be confirmed by large samples and high-quality RCT studies.
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Expert Rev Clin Pharmacol · Feb 2020
ReviewAclidinium bromide and formoterol fumarate for the maintenance treatment of chronic obstructive pulmonary disease.
Introduction: Treatment options for COPD have evolved rapidly in the last decade and inhaled bronchodilators have largely supplanted the use of oral bronchodilators because of their increased efficacy and excellent safety with topical delivery to the lung. Recently added to the therapeutic armamentarium are fixed-dose combinations (FDC) of two long acting bronchodilators. LAMAs (long acting muscarinic antagonists) and LABAs (long acting beta agonists) are the main classes available and use different pathways to effectively produce bronchial smooth muscle relaxation. ⋯ These individual drugs have excellent efficacy and safety records for the maintenance treatment of COPD. Studies have demonstrated that twice daily treatment with aclidinium/formoterol resulted in significant improvement in lung function and an improved exercise tolerance when compared to placebo. Adverse effects are within the range of what is seen with other LAMA/LABA combinations.
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Expert Rev Clin Pharmacol · May 2021
ReviewBempedoic Acid: a cholesterol lowering agent with a novel mechanism of action.
Dyslipidemia is a common condition that increases the risk of heart diseases and stroke. High levels of low-density lipoprotein-cholesterol (LDL-C) are correlated with a higher risk for heart disease. A drug class known as 'statins' is the gold standard for LDL-C-lowering, but its use in some patients is limited by its adverse effects of myalgias and myopathies. Use of other LDL-C-lowering agents is frequently limited by cost and degree of efficacy. Additionally, many high-risk atherosclerotic cardiovascular disease patients fail to meet LDL-C goals despite maximally tolerated statin therapy with or without the addition of a non-statin agent. ⋯ Bempedoic acid has not been shown to cause myalgias or myopathies and is likely to be competitively affordable compared to other LDL-C-lowering agents. Bempedoic acid has been shown to be superior compared to placebo and provides additional LDL-C lowering on top of maximally tolerated statin therapy or combined with ezetimibe alone.