Expert review of neurotherapeutics
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Expert Rev Neurother · May 2008
ReviewFrovatriptan for the acute treatment of migraine and prevention of predictable menstrual migraine.
Frovatriptan is a 5-HT(1B/1D) receptor agonist that belongs to the triptan therapeutic class. Relative to other triptans, frovatriptan has a long half-life (26 h) and a low incidence of migraine recurrence (17%). ⋯ Recent studies have also shown that a 6-day regimen of frovatriptan scheduled during the perimenstrual period significantly reduced the incidence and severity of menstrual migraine (MM; attacks that regularly start day -2 to +3 relative to menses). Prevention may be important because MM attacks have been characterized as being of longer duration, more severe and more refractory to treatment than non-MM attacks.
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Expert Rev Neurother · Apr 2008
ReviewDuloxetine in the treatment of major psychiatric and neuropathic disorders.
Major depressive disorder (MDD) is one of the most disabling disorders. Antidepressant pharmacotherapy is currently effective in approximately 70% of all treated cases; the potential superiority of a dual mechanism of pharmacological action (e.g., inhibiting the reuptake of serotonin and norepinephrine) is widely known. Duloxetine, a novel dual acting, selective serotonin and norepinephrine reuptake inhibitor, has demonstrated clinical efficacy in the treatment of MDD and general anxiety disorder (GAD). ⋯ Overall, duloxetine is an interesting novel treatment option in the management of major depression and has shown efficacy in a broad range of diseases. It therefore may provide additional benefit to current therapeutic options in the treatment of psychiatric, internal, as well as urological disorders such as spinal dysfunctions. Due to duloxetine's properties, a wide range of use will be encountered in the mid-to-long term.
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The term chronic daily headache (CDH) identifies a heterogeneous group of headaches characterized by the presence of daily or near-daily headache, including forms associated with medication overuse. This group includes chronic (transformed) migraine, chronic tension-type headache, new daily-persistent headache and hemicrania continua. According to population studies, CDH affects 4-5% of the general population worldwide, making it a significant social problem. ⋯ The classification of CDH continues to be debated, even though the recent revision of the diagnostic criteria for several primary headache forms seems to have resolved some of the nosographical difficulties. To date, no specific therapies have been approved for CDH and there have been few large-scale controlled trials of treatments in this area. This article reviews various aspects of CDH: classification issues, pathophysiological hypotheses and therapeutic (pharmacological and nonpharmacological) approaches.
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Therapeutic monoclonal antibodies (mAbs) are potent new tools for a molecular targeted approach to modify the course of multiple sclerosis (MS). Besides natalizumab, which was approved in 2006, three other mAbs (alemtuzumab, rituximab and daclizumab) were successfully tested in Phase II MS trials. In this review, introductory notes on the development and systematic nomenclature of therapeutic mAbs in general, set the stage for a detailed discussion of the four mAbs mentioned. ⋯ Particularly, we provide a critical discussion of clinical MS trials, including protocols and interim analyses of trials currently underway. The natalizumab section pays special attention to the clinical handling of safety issues and the diagnostic use of neutralizing antibodies. We finally develop a scenario for how each of the four mAbs might evolve into the market of MS therapeutics within the coming years.
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Expert Rev Neurother · Dec 2007
ReviewTramadol extended-release formulations in the management of pain due to osteoarthritis.
Tramadol is a centrally acting, synthetic analgesic. Its mechanism of action involves weak binding to the mu-opioid receptors and inhibition of reuptake of both norepinephrine and serotonin. It has been used to treat moderate-to-severe pain for 30 years in Europe and more than 10 years in the USA. ⋯ Generally, adverse events are typical of tramadol (constipation, nausea, dizziness and somnolence). Descriptively, a trend to comparable or lower incidence and severity of adverse events seems apparent with the various once-daily formulations. Tramadol once-daily formulations are more effective than placebo and at least as effective and well tolerated as immediate-release formulations in the treatment of pain due to osteoarthritis, and offer a reduced dosing regimen, which is especially valuable in elderly patients.